Healthcare Provider Details

I. General information

NPI: 1427059252
Provider Name (Legal Business Name): NEDAL MACHHOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 EAGLECREEK
IRVINE CA
92618-3956
US

IV. Provider business mailing address

67 EAGLECREEK
IRVINE CA
92618-3956
US

V. Phone/Fax

Practice location:
  • Phone: 949-981-5759
  • Fax: 949-387-5421
Mailing address:
  • Phone: 949-981-5759
  • Fax: 949-387-5421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA69530
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: