=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679728190
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIELLA A PATTERSON-MACHO PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2008
-----------------------------------------------------
Last Update Date | 01/03/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10683 MAGNOLIA AVE STE B
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92505-1893
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-509-9000
-----------------------------------------------------
Fax | 951-506-0992
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1701 E FLORIDA AVE
-----------------------------------------------------
City | HEMET
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92544-4632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-658-4486
-----------------------------------------------------
Fax | 951-925-1666
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA 20089
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------