Provider Demographics
NPI:1720387319
Name:MACIAS, CARLOS AITOR (MD, MPH, FACS)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:AITOR
Last Name:MACIAS
Suffix:
Gender:M
Credentials:MD, MPH, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:255 TERRACINA BLVD STE 104B
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4870
Mailing Address - Country:US
Mailing Address - Phone:909-793-3293
Mailing Address - Fax:909-793-0083
Practice Address - Street 1:255 TERRACINA BLVD STE 104B
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4870
Practice Address - Country:US
Practice Address - Phone:909-793-3293
Practice Address - Fax:909-793-0083
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2013-01981208600000X
NJ25MA09005600208600000X
CAA121442208600000X
NMMD2015-0456208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery