Provider Demographics
NPI:1750848867
Name:MACHINA, ALISA
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:MACHINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 N MIAMI AVE APT 2211
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33128-1939
Mailing Address - Country:US
Mailing Address - Phone:347-668-8708
Mailing Address - Fax:
Practice Address - Street 1:240 N MIAMI AVE APT 2211
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33128-1939
Practice Address - Country:US
Practice Address - Phone:347-668-8708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA17398235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102168800Medicaid