Provider Demographics
NPI:1104356138
Name:MACHUCA FAMILY MEDICINE AT JONES
Entity Type:Organization
Organization Name:MACHUCA FAMILY MEDICINE AT JONES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHUCA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:702-906-2976
Mailing Address - Street 1:6110 ELTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2538
Mailing Address - Country:US
Mailing Address - Phone:702-906-2976
Mailing Address - Fax:702-906-2977
Practice Address - Street 1:6110 ELTON AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-2538
Practice Address - Country:US
Practice Address - Phone:702-906-2976
Practice Address - Fax:702-906-2977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty