Healthcare Provider Details

I. General information

NPI: 1437941069
Provider Name (Legal Business Name): KRISTINE MACHADO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1254 COTTONWOOD ST
TULARE CA
93274-6395
US

IV. Provider business mailing address

1254 COTTONWOOD ST
TULARE CA
93274-6395
US

V. Phone/Fax

Practice location:
  • Phone: 805-286-2529
  • Fax:
Mailing address:
  • Phone: 805-286-2529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335G00000X
TaxonomyMedical Foods Supplier
License Number
License Number State

VIII. Authorized Official

Name: KRISTINE MACHADO
Title or Position: OWNER/OPERATOR
Credential:
Phone: 559-269-6796