Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | MFC1732 | FL |
NPI | 1194116004 |
---|---|
Provider Name | Dr. Desiree M M S Machado |
First Address | Gainesville, FL 32610-0297 |
Second Address | Gainesville, FL 32608-1136 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2015 |
Last Update Date | 20/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
014369800 | (05) | FL |