Individual
IAN MAESTAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
904 E FAIRVIEW LN, ESPANOLA, NM 87532-2822
(505) 747-1991
Mailing address
282 S CAMINO DEL PUEBLO STE C, BERNALILLO, NM 87004-5909
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/09/2015
Last updated
06/09/2015
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