Healthcare Provider Details

I. General information

NPI: 1629292297
Provider Name (Legal Business Name): VALLEY RADIOLOGIST MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 BAYWOOD AVE # 2
SAN MATEO CA
94402-1516
US

IV. Provider business mailing address

35 BAYWOOD AVE # 2
SAN MATEO CA
94402-1516
US

V. Phone/Fax

Practice location:
  • Phone: 650-685-1100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: EDITH GUARDADO
Title or Position: PSRTL
Credential:
Phone: 650-685-1100