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General NPI Number Information
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NPI Number | 1902100597
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Entity Type | Individual
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Provider Name | JULIE ANNETTE MACHUCA PA
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Gender | Female
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Dates
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Enumeration Date | 12/22/2010
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 1300 W TERRELL AVE STE 405
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City | FORT WORTH
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State | TX
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Zip | 76104-2810
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Country | US
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Telephone | 817-303-4521
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Fax | 817-468-5876
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Provider Business Mailing Address
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Address Line | 9003 AIRPORT FWY SUITE 300
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City | NORTH RICHLAND HILLS
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State | TX
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Zip | 76180-7770
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Country | US
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Telephone | 817-514-5200
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Fax | 817-514-5210
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA07108
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License Number State | TX
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