Provider Demographics
NPI:1013083765
Name:MACHIN, TOMAS MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:TOMAS
Middle Name:MANUEL
Last Name:MACHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3857
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93403-3857
Mailing Address - Country:US
Mailing Address - Phone:800-472-9116
Mailing Address - Fax:805-439-0324
Practice Address - Street 1:508 E HICKORY STREET
Practice Address - Street 2:LOMPOC DISTRICT HOSPITAL
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93438-1058
Practice Address - Country:US
Practice Address - Phone:805-737-5718
Practice Address - Fax:805-735-4027
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA402330207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A402330Medicaid
CAGR0016631Medicaid
CA1356409379OtherGROUP NPI
CA220018774OtherRAILROAD MEDICARE
CAA402330OtherMEDICAL BOARD OF CA
CAZZZ42967ZOtherBLUE SHIELD
CA1356409379OtherGROUP NPI
CAA402330OtherMEDICAL BOARD OF CA
CAHW8260AMedicare PIN