MEDICARE: MYRKA PAOLA MACEDO MD

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1477494177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYRKA PAOLA MACEDO MD

Provider Business Mailing Address
First Line	:	3020 CHILDRENS WAY
Second Line	:	MC5124
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4223
Country	:	US
Telephone Number	:	858-966-6764
Fax Number	:	858-966-7966

Provider Business Practice Location Address
First Line	:	3020 CHILDRENS WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4223
Country	:	US
Telephone Number	:	858-966-6764
Fax Number	:	858-966-7966

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

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/08/2026

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