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General NPI Number Information
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NPI Number | 1376768747
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Entity Type | Organization
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Legal Business Name | GUSTAVO A. MACHICADO M.D.
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 03/07/2019
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Provider Practice Location Address
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Address Line | 18350 ROSCOE BLVD. SUITE 303
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City | NORTHRIDGE
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State | CA
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Zip | 91325-4157
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Country | US
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Telephone | 818-885-6261
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Fax | 818-885-5384
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Provider Business Mailing Address
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Address Line | 18350 ROSCOE BLVD STE 604
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City | NORTHRIDGE
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State | CA
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Zip | 91325-4190
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Country | US
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Telephone | 818-885-6261
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Fax | 818-885-5384
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Authorized Official
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Title or Position | PRESIDENT
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Name | GUSTAVO A MACHICADO
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Credential | M.D.
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Telephone | 818-885-6261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | G30863
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License Number State | CA
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