Provider Demographics
NPI:1679728190
Name:PATTERSON-MACHO, DANIELLA A (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLA
Middle Name:A
Last Name:PATTERSON-MACHO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DANI
Other - Middle Name:
Other - Last Name:MACHO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1701 E FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-4632
Mailing Address - Country:US
Mailing Address - Phone:951-658-4486
Mailing Address - Fax:951-925-1666
Practice Address - Street 1:10683 MAGNOLIA AVE STE B
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-1893
Practice Address - Country:US
Practice Address - Phone:951-509-9000
Practice Address - Fax:951-506-0992
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 20089363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant