Individual
GUSTAVO A MACHICADO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
18350 ROSCOE BLVD STE 604, NORTHRIDGE, CA 91325-4190
(818) 885-6261
(818) 885-8256
Mailing address
18350 ROSCOE BLVD STE 604, NORTHRIDGE, CA 91325-4190
(818) 885-6261
(818) 885-8256
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
G308630
CA
207RG0100X
Gastroenterology Physician
Primary
G308630
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G308630
—
CA
Enumeration date
02/03/2006
Last updated
04/10/2018
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