Healthcare Provider Details

I. General information

NPI: 1598733727
Provider Name (Legal Business Name): LESTER MACHADO M.D., D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 WASHINGTON ST SUITE #710
SAN DIEGO CA
92103-2231
US

IV. Provider business mailing address

501 WASHINGTON ST SUITE #710
SAN DIEGO CA
92103-2231
US

V. Phone/Fax

Practice location:
  • Phone: 619-295-6774
  • Fax: 619-295-6776
Mailing address:
  • Phone: 619-295-6774
  • Fax: 619-295-6776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD29080
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: