Organization
EDGAR S. MACIAS, M.D., INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VANESSA CANEZ (OFFICE MANAGER)
(559) 431-2397
Entity
Organization
Contact information
Practice address
7115 N CHESTNUT AVE STE 101, FRESNO, CA 93720-0361
(559) 431-2397
(559) 472-3382
Mailing address
7115 N CHESTNUT AVE STE 101, FRESNO, CA 93720-0361
(559) 431-2397
(559) 472-3382
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
A112259
CA
332900000X
Non-Pharmacy Dispensing Site
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144482373
INIVIDUAL NPI
—
Enumeration date
03/31/2011
Last updated
06/06/2019
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