Provider Demographics
NPI:1386967867
Name:MAESTAS, PATRICK (BA)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:MAESTAS
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 SPRUCE AVE SPC 54
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-2467
Mailing Address - Country:US
Mailing Address - Phone:575-650-5550
Mailing Address - Fax:
Practice Address - Street 1:1625 SPRUCE AVE SPC 54
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-2467
Practice Address - Country:US
Practice Address - Phone:575-650-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator