Healthcare Provider Details

I. General information

NPI: 1710006333
Provider Name (Legal Business Name): RAUL MACHADO LSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14310 CASTLEMAINE CT
SUGAR LAND TX
77498-9748
US

IV. Provider business mailing address

14310 CASTLEMAINE CT
SUGAR LAND TX
77498-9748
US

V. Phone/Fax

Practice location:
  • Phone: 832-461-6098
  • Fax:
Mailing address:
  • Phone: 832-461-6098
  • Fax: 713-779-9813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA00129
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License NumberSA00129
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberSA00129
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: