MEDICARE: ANTHONY SADA MATOS R.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2471C3402X	Radiography Radiologic Technologist	989	PR

General Provider Information

NPI Number	:	1447356472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY SADA MATOS R.T.

Provider Business Mailing Address
First Line	:	ED10 CALLE PINO
Second Line	:	LOS ALMENDROS
City	:	BAYAMON
State	:	PR
Zip	:	00961-3404
Country	:	US
Telephone Number	:	787-309-2663
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 AVE LAUREL
Second Line	:	SANTA JUANITA
City	:	BAYAMON
State	:	PR
Zip	:	00956-4816
Country	:	US
Telephone Number	:	787-787-5151
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	07/08/2007

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