1013083765 NPI number — TOMAS MANUEL MACHIN MD

Table of content: TOMAS MANUEL MACHIN MD (NPI 1013083765)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013083765 NPI number — TOMAS MANUEL MACHIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACHIN
Provider First Name:
TOMAS
Provider Middle Name:
MANUEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013083765
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3857
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN LUIS OBISPO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93403-3857
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-472-9116
Provider Business Mailing Address Fax Number:
805-439-0324

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
508 E HICKORY STREET
Provider Second Line Business Practice Location Address:
LOMPOC DISTRICT HOSPITAL
Provider Business Practice Location Address City Name:
LOMPOC
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93438-1058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-737-5718
Provider Business Practice Location Address Fax Number:
805-735-4027
Provider Enumeration Date:
11/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  A402330 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A402330 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0016631 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1356409379 . This is a "GROUP NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 220018774 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: A402330 . This is a "MEDICAL BOARD OF CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ42967Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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