Individual
JACK ADRIAN MAESTAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CCSS
Contact information
Practice address
203 CALIFORNIA ST NE, ALBUQUERQUE, NM 87108-1802
(505) 308-8296
Mailing address
203 CALIFORNIA ST NE, ALBUQUERQUE, NM 87108-1802
(505) 308-8296
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/18/2020
Last updated
12/18/2020
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