Provider Demographics
NPI:1689328809
Name:MACHADO, DAVID JOSHUA
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOSHUA
Last Name:MACHADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 CALLE FRONDOSA
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-4044
Mailing Address - Country:US
Mailing Address - Phone:909-609-1496
Mailing Address - Fax:
Practice Address - Street 1:510 S 2ND AVE STE 7
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3017
Practice Address - Country:US
Practice Address - Phone:626-332-7788
Practice Address - Fax:626-974-8198
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator