Healthcare Provider Details

I. General information

NPI: 1437556156
Provider Name (Legal Business Name): JOSEPH DANIEL MATTHEWS RDCS, RVT, RDMS, RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 NIELSON ST, 101
WATSONVILLE CA
95076-2491
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 Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number71989
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number71989
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License Number71989
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: