MEDICARE: MARLENE CHRIS MACHADO PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA9102958	FL

General Provider Information

NPI Number	:	1013244755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLENE CHRIS MACHADO PA-C

Provider Business Mailing Address
First Line	:	15951 SW 6TH ST
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33027-1161
Country	:	US
Telephone Number	:	305-467-4217
Fax Number	:

Provider Business Practice Location Address
First Line	:	4578 W 12TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3325
Country	:	US
Telephone Number	:	53-828-1989
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2009
Last Update Date	:	10/08/2024

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