Basic Information
| Provider Information | |||||||||
| NPI: | 1467608794 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SHADIOW | ||||||||
| FirstName: | MATHEW | ||||||||
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| Credential: | CRT, ARRT, CA FLUORO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 612855 | ||||||||
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| 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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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247100000X | RHF 74300 | CA | Y | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | 247100000X | ARRT313398 | MN | N | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist |
No ID Information.