Provider Demographics
NPI:1982984175
Name:J.C.MACHADO, JR.M.D.,P.A.
Entity type:Organization
Organization Name:J.C.MACHADO, JR.M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PD
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:C
Authorized Official - Last Name:MACHADO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:305-450-2774
Mailing Address - Street 1:4800 RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1737
Mailing Address - Country:US
Mailing Address - Phone:305-450-2774
Mailing Address - Fax:877-403-3837
Practice Address - Street 1:4800 RIVIERA DR
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-1737
Practice Address - Country:US
Practice Address - Phone:305-450-2774
Practice Address - Fax:877-403-3837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00565882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL051907300Medicaid