Provider Demographics
NPI:1023551355
Name:ROGELIO MACHUCA MD FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:ROGELIO MACHUCA MD FAMILY MEDICINE, PLLC
Other - Org Name:MACHUCA BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGELIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHUCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-778-7614
Mailing Address - Street 1:546 N EASTERN AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-3485
Mailing Address - Country:US
Mailing Address - Phone:702-778-7614
Mailing Address - Fax:702-778-7615
Practice Address - Street 1:546 N EASTERN AVE STE 140
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-3485
Practice Address - Country:US
Practice Address - Phone:702-778-7614
Practice Address - Fax:702-778-7615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-17
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVG64-07911101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty