Individual
JENIFFER DIANE MACHUCA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
3929 E BELL RD, PHOENIX, AZ 85032-2112
(541) 789-7000
Mailing address
2005 S SERTOMA AVE, SIOUX FALLS, SD 57106-4560
(480) 399-8020
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9965
AZ
Other
Enumeration date
11/09/2021
Last updated
04/06/2024
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