Provider Demographics
NPI:1295871549
Name:MACHOVCOVA, MARTINA
Entity type:Individual
Prefix:MISS
First Name:MARTINA
Middle Name:
Last Name:MACHOVCOVA
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 1:1614 W SANTA MARIA WAY
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4483
Mailing Address - Country:US
Mailing Address - Phone:408-506-8515
Mailing Address - Fax:
Practice Address - Street 1:281 W 24TH ST
Practice Address - Street 2:SUITE 126
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8500
Practice Address - Country:US
Practice Address - Phone:928-344-6856
Practice Address - Fax:928-344-6930
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool