Basic Information
| Provider Information | |||||||||
| NPI: | 1578725461 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAGALLON | ||||||||
| FirstName: | MARIO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RADIOLOGY TECH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 659 S CENTRAL VALLEY HWY | ||||||||
| Address2: | |||||||||
| City: | SHAFTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932632790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6614591913 | ||||||||
| FaxNumber: | 6614591974 | ||||||||
| Practice Location | |||||||||
| Address1: | 655 S CENTRAL VALLEY HWY | ||||||||
| Address2: | |||||||||
| City: | SHAFTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932632790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617469194 | ||||||||
| FaxNumber: | 6617469197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2008 | ||||||||
| LastUpdateDate: | 07/01/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247100000X | RHP00089002 | CA | Y | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist |
No ID Information.