Provider Demographics
NPI:1790088342
Name:JAMES R MACHO MD
Entity Type:Organization
Organization Name:JAMES R MACHO MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROUCHEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:VAQUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-775-2795
Mailing Address - Street 1:909 HYDE ST
Mailing Address - Street 2:SUITE 325
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4822
Mailing Address - Country:US
Mailing Address - Phone:415-775-2795
Mailing Address - Fax:415-775-3025
Practice Address - Street 1:909 HYDE ST
Practice Address - Street 2:SUITE 325
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4822
Practice Address - Country:US
Practice Address - Phone:415-775-2795
Practice Address - Fax:415-775-3025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46469208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA-50396Medicare UPIN
CA00G464690Medicare PIN