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General NPI Number Information
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NPI Number | 1669694246
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Entity Type | Individual
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Provider Name | JENNIFER LYNN MACHUCA M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 7371 BRANDT PIKE STE D
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City | HUBER HEIGHTS
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State | OH
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Zip | 45424-3276
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Country | US
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Telephone | 937-795-1101
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Fax | 937-795-1120
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Provider Business Mailing Address
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Address Line | 7371 BRANDT PIKE STE D
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City | HUBER HEIGHTS
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State | OH
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Zip | 45424-3276
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Country | US
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Telephone | 937-795-1101
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Fax | 937-795-1120
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35.092123
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License Number State | OH
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