Healthcare Provider Details

I. General information

NPI: 1275944134
Provider Name (Legal Business Name): DR ISAREL MACHIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 FOREST HILL BLVD STE C
LAKE CLARKE FL
33406-6077
US

IV. Provider business mailing address

1511 FOREST HILL BLVD STE C
LAKE CLARKE FL
33406-6077
US

V. Phone/Fax

Practice location:
  • Phone: 561-433-3556
  • Fax:
Mailing address:
  • Phone: 561-433-3556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTINE MCDUFFY
Title or Position: PSAO
Credential:
Phone: 913-451-5784