Provider Demographics
NPI:1801224233
Name:MACHMUD, LARRY (PT)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:MACHMUD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1676 E 6TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-5760
Mailing Address - Country:US
Mailing Address - Phone:951-769-0300
Mailing Address - Fax:951-769-2811
Practice Address - Street 1:12730 HEACOCK ST
Practice Address - Street 2:4B
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3070
Practice Address - Country:US
Practice Address - Phone:951-924-8300
Practice Address - Fax:951-924-8331
Is Sole Proprietor?:No
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA393442081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine