Healthcare Provider Details

I. General information

NPI: 1386621100
Provider Name (Legal Business Name): GREGORY J. MACCHIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27700 MEDICAL CENTER RD
MISSION VIEJO CA
92691-6426
US

IV. Provider business mailing address

27401 LOS ALTOS SUITE 180
MISSION VIEJO CA
92691-6316
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-1400
  • Fax:
Mailing address:
  • Phone: 949-582-9624
  • Fax: 949-582-9626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01044919A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: