Provider Demographics
NPI:1801597372
Name:MACHUCA, SAMUEL (FNP-C)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:MACHUCA
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 WEST LOOP S STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3535
Mailing Address - Country:US
Mailing Address - Phone:713-486-2900
Mailing Address - Fax:
Practice Address - Street 1:6500 WEST LOOP S STE 200
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3535
Practice Address - Country:US
Practice Address - Phone:713-486-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1131191363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty