Healthcare Provider Details

I. General information

NPI: 1699328609
Provider Name (Legal Business Name): CARMEN MACHUA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8937 NW 3RD CT
CORAL SPRINGS FL
33071-7417
US

IV. Provider business mailing address

8937 NW 3RD CT
CORAL SPRINGS FL
33071-7417
US

V. Phone/Fax

Practice location:
  • Phone: 786-274-2812
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-70058
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: