Provider Demographics
NPI:1225385685
Name:MAESTAS, DAVID WILLIAM (LADAC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WILLIAM
Last Name:MAESTAS
Suffix:
Gender:M
Credentials:LADAC
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:WILLIAM
Other - Last Name:MAESTAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CADAC
Mailing Address - Street 1:713 MCKNIGHT AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1238
Mailing Address - Country:US
Mailing Address - Phone:505-304-7420
Mailing Address - Fax:505-200-0061
Practice Address - Street 1:2520 VIRGINIA ST NE
Practice Address - Street 2:STE 200
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4689
Practice Address - Country:US
Practice Address - Phone:505-296-4449
Practice Address - Fax:505-296-0497
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-04
Last Update Date:2012-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1028971101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)