Provider Demographics
NPI:1184930174
Name:MACHADO, JONATHAN LAWRENCE
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:LAWRENCE
Last Name:MACHADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 N ENTERPRISE ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-9760
Mailing Address - Country:US
Mailing Address - Phone:949-735-0774
Mailing Address - Fax:
Practice Address - Street 1:651 N ENTERPRISE ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-9760
Practice Address - Country:US
Practice Address - Phone:949-735-0774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21119363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant