Basic Information
| Provider Information | |||||||||
| NPI: | 1104356138 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MACHUCA FAMILY MEDICINE AT JONES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6110 ELTON AVE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891072538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029062976 | ||||||||
| FaxNumber: | 7029062977 | ||||||||
| Practice Location | |||||||||
| Address1: | 6110 ELTON AVE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891072538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029062976 | ||||||||
| FaxNumber: | 7029062977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2017 | ||||||||
| LastUpdateDate: | 06/13/2017 | ||||||||
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| AuthorizedOfficialLastName: | MACHUCA | ||||||||
| AuthorizedOfficialFirstName: | MARIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | APRN | ||||||||
| AuthorizedOfficialTelephone: | 7029062976 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | APRN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.