Individual
MARK A MAESTAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
YOUTHCARE SPECIALIST
Contact information
Practice address
1621 SUTTER PLACE, CLOVIS, NM 88101
(575) 769-2345
(575) 769-9013
Mailing address
1100 W. 21ST STREET, CLOVIS, NM 88101
(575) 769-2345
(575) 769-9013
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
09/01/2009
Last updated
03/17/2015
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