Provider Demographics
NPI:1285055970
Name:PATRICIA A MACIOG, MD
Entity type:Organization
Organization Name:PATRICIA A MACIOG, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACIOG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-938-7129
Mailing Address - Street 1:6226 E SPRING ST
Mailing Address - Street 2:240
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1423
Mailing Address - Country:US
Mailing Address - Phone:562-928-7129
Mailing Address - Fax:562-938-7431
Practice Address - Street 1:6226 E SPRING ST
Practice Address - Street 2:240
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1423
Practice Address - Country:US
Practice Address - Phone:562-928-7129
Practice Address - Fax:562-938-7431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA049415261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC93195Medicare UPIN