Individual
AUDREY MACASIEB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1625 SCHRADER BLVD, LOS ANGELES, CA 90028-6213
(323) 993-8910
Mailing address
1625 SCHRADER BLVD, LOS ANGELES, CA 90028-6213
(323) 993-8910
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
708700
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01536011
MEDI-CAL
CA
Enumeration date
02/25/2019
Last updated
02/25/2019
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