| Gustavo A. Machicado M.d. | |
|
18350 Roscoe Blvd. Suite 303 Northridge CA 91325-4157 | |
| (818) 885-6261 | |
| (818) 885-5384 |
| Full Name | Gustavo A. Machicado M.d. |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 18350 Roscoe Blvd., Northridge, California |
| Authorized Official Name and Position | Gustavo A Machicado (PRESIDENT) |
| Authorized Official Contact | 8188856261 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gustavo A. Machicado M.d. 18350 Roscoe Blvd Ste 604 Northridge CA 91325-4190 Ph: (818) 885-6261 | Gustavo A. Machicado M.d. 18350 Roscoe Blvd. Suite 303 Northridge CA 91325-4157 Ph: (818) 885-6261 |
| NPI Number | 1376768747 |
|---|---|
| Provider Enumeration Date | 04/13/2007 |
| Last Update Date | 03/07/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376768747 | NPI | - | NPPES |
| 00G308630 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | G30863 (California) | Primary |
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