Individual
SANTIAGO R. MACIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2001 EL CENTRO FAMILIAR BLVD SW, ALBUQUERQUE, NM 87105-4592
(505) 873-7400
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD2004-0045
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17808014
—
NM
Enumeration date
07/07/2005
Last updated
05/07/2018
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