Individual
MAYRA ALEJANDRA MACIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDA
Contact information
Practice address
179 N TUSTIN ST, ORANGE, CA 92867-7716
(714) 598-3923
Mailing address
179 N TUSTIN ST, ORANGE, CA 92867-7716
(714) 598-3923
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
90133
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
90133
—
CA
Enumeration date
06/13/2020
Last updated
06/13/2020
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