Provider Demographics
NPI:1922242676
Name:MACHUCA, FRANCISCO GUADALUPE (MD)
Entity Type:Individual
Prefix:
First Name:FRANCISCO
Middle Name:GUADALUPE
Last Name:MACHUCA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15969 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-6325
Mailing Address - Country:US
Mailing Address - Phone:530-990-6519
Mailing Address - Fax:702-850-9105
Practice Address - Street 1:1513 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3916
Practice Address - Country:US
Practice Address - Phone:702-340-9746
Practice Address - Fax:702-850-9105
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-25
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16108207Q00000X
NE26368207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE086248026Medicare PIN