Healthcare Provider Details

I. General information

NPI: 1487041406
Provider Name (Legal Business Name): MATTHEW ABAD-SANTOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SAN PABLO ST 2ND FLOOR RADIOLOGY
LOS ANGELES CA
90033
US

IV. Provider business mailing address

1500 SAN PABLO ST
LOS ANGELES CA
90033-5313
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-8541
  • Fax:
Mailing address:
  • Phone: 323-442-8541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA144716
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number61048427
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: