Provider Demographics
NPI:1194758086
Name:MACIAS, HENRY D (PA)
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:D
Last Name:MACIAS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:26821 MAGDALENA LN
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6223
Mailing Address - Country:US
Mailing Address - Phone:714-801-5614
Mailing Address - Fax:
Practice Address - Street 1:26821 MAGDALENA LN
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6223
Practice Address - Country:US
Practice Address - Phone:714-801-5614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16828363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP94561Medicare UPIN