Healthcare Provider Details

I. General information

NPI: 1902173248
Provider Name (Legal Business Name): ULTRASOUND LABORATORIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 SOUTH DRIVE, 7
MOUNTAIN VIEW CA
94040-4207
US

IV. Provider business mailing address

PO BOX 4864
MOUNTAIN VIEW CA
94040-0864
US

V. Phone/Fax

Practice location:
  • Phone: 408-829-6486
  • Fax: 408-890-4770
Mailing address:
  • Phone: 408-829-6486
  • Fax: 408-890-4770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number71989
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number71989
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number71989
License Number State
# 4
Primary TaxonomyN
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License Number71989
License Number State
# 5
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number71989
License Number State

VIII. Authorized Official

Name: JOSEPH DANIEL MATTHEWS
Title or Position: TECHNICAL DIRECTOR, PRESIDENT
Credential: RDMS, RVT, RDCS,RPHS
Phone: 408-829-6486