Provider Demographics
NPI:1336910744
Name:MACIAS-ZACARIAS, JOSE DE JESUS (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:DE JESUS
Last Name:MACIAS-ZACARIAS
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:
Other - Last Name:MACIAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AGACNP-BC
Mailing Address - Street 1:447 DEBORAH DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2377
Mailing Address - Country:US
Mailing Address - Phone:626-536-9684
Mailing Address - Fax:
Practice Address - Street 1:447 DEBORAH DR
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2377
Practice Address - Country:US
Practice Address - Phone:626-536-9684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028662363LA2200X, 363LC0200X, 363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology