Healthcare Provider Details

I. General information

NPI: 1952644098
Provider Name (Legal Business Name): LESTER MACHADO, M.D., D.D.S., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 WASHINGTON ST STE 710
SAN DIEGO CA
92103-2231
US

IV. Provider business mailing address

501 WASHINGTON ST STE 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 Number
License Number State

VIII. Authorized Official

Name: MRS. VERONICA G ELIAS
Title or Position: OFFICE MANAGER
Credential:
Phone: 619-295-6774