Healthcare Provider Details

I. General information

NPI: 1275579047
Provider Name (Legal Business Name): JULIO C MACHADO JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15536 SW 36TH TER
MIAMI FL
33185-4811
US

IV. Provider business mailing address

15536 SW 36TH TER
MIAMI FL
33185-4811
US

V. Phone/Fax

Practice location:
  • Phone: 305-450-2774
  • Fax: 305-675-8028
Mailing address:
  • Phone: 305-450-2774
  • Fax: 305-675-8028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberME0056588
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: