Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | MFC1730 | FL |
NPI | 1013305648 |
---|---|
Provider Name | Tiago Noguchi Machuca |
First Address | Philadelphia, PA 19101-3833 |
Second Address | Gainesville, FL 32610-0129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2015 |
Last Update Date | 04/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
014106200 | (05) | FL |