Basic Information
| Provider Information | |||||||||
| NPI: | 1447406772 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACCESS RADIOLOGY TECHS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 612855 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951612855 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4088292235 | ||||||||
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| Practice Location | |||||||||
| Address1: | 570 WILLOW RD | ||||||||
| Address2: | |||||||||
| City: | MENLO PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940252617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503248500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2008 | ||||||||
| LastUpdateDate: | 08/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | SHADIOW | ||||||||
| AuthorizedOfficialFirstName: | MATHEW | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4088292235 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | ARRT, CRT, CA FLUORO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 335V00000X | 177016308 | CA | Y | Suppliers | Portable X-Ray Supplier |
No ID Information.