Healthcare Provider Details

I. General information

NPI: 1447356472
Provider Name (Legal Business Name): ANTHONY SADA MATOS R.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 AVE LAUREL SANTA JUANITA
BAYAMON PR
00956-4816
US

IV. Provider business mailing address

ED10 CALLE PINO LOS ALMENDROS
BAYAMON PR
00961-3404
US

V. Phone/Fax

Practice location:
  • Phone: 787-787-5151
  • Fax:
Mailing address:
  • Phone: 787-309-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number989
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: