Charles James Maestas, MD
Individual provider Active NPI Family Medicine Physician · Pojoaque, NM
NPI 1629109772 · NPPES record last updated Aug 26, 2020
Key facts
- NPI
- 1629109772
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 88-216 (NM)
- Practice address
- 5 Petrogyph Circle
Ste. B
Pojoaque, NM 87506-0810 - Phone
- (505) 455-2842
- Fax
- (505) 455-2941
- NPI assigned
- Mar 8, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 88-216 | NM | Yes |
Addresses
Primary practice location
5 Petrogyph Circle
Ste. B
Pojoaque, NM 87506-0810
Mailing address
5 Petroglyph Cir Ste B
Santa Fe, NM 87506-1001
Phone (505) 455-2842
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 07930 | Medicaid | NM |
Other providers in Pojoaque, NM
All providers in Pojoaque, NM · Family Medicine Physician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 26, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.