Organization
GUSTAVO A. MACHICADO M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GUSTAVO A MACHICADO M.D. (PRESIDENT)
(818) 885-6261
Entity
Organization
Contact information
Practice address
18350 ROSCOE BLVD., SUITE 303, NORTHRIDGE, CA 91325-4157
(818) 885-6261
(818) 885-5384
Mailing address
18350 ROSCOE BLVD STE 604, NORTHRIDGE, CA 91325-4190
(818) 885-6261
(818) 885-5384
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
G30863
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G308630
—
CA
Enumeration date
04/13/2007
Last updated
03/07/2019
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