Provider Demographics
NPI:1902523269
Name:MACHUCA, PATTY
Entity type:Individual
Prefix:
First Name:PATTY
Middle Name:
Last Name:MACHUCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 KEMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755-4026
Mailing Address - Country:US
Mailing Address - Phone:626-476-6770
Mailing Address - Fax:
Practice Address - Street 1:900 KEMPTON AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91755-4026
Practice Address - Country:US
Practice Address - Phone:626-476-6770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program