Organization
ACCESS HEALTH CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LIBERTY MACIAS PMHNP-BC (CEO)
(909) 894-4260
Entity
Organization
Contact information
Practice address
26070 LUGO DR, LOMA LINDA, CA 92354-6507
(909) 900-6465
(888) 505-0620
Mailing address
26070 LUGO DR, LOMA LINDA, CA 92354-6507
(909) 894-4260
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95002264
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CA154839
MEDICARE PTAN
CA
01
—
CB236524
MEDICARE PTAN
CA
Enumeration date
09/16/2015
Last updated
09/16/2015
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