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General NPI Number Information
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NPI Number | 1447511464
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Entity Type | Organization
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Legal Business Name | AMADOR VALLEY DENTAL X-RAY INC.
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Dates
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Enumeration Date | 06/06/2012
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Last Update Date | 06/06/2012
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Provider Practice Location Address
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Address Line | 1475 CEDARWOOD LN STE D
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City | PLEASANTON
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State | CA
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Zip | 94566-6128
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Country | US
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Telephone | 925-846-9291
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Fax | 925-846-9260
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Provider Business Mailing Address
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Address Line | 1475 CEDARWOOD LN STE D
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City | PLEASANTON
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State | CA
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Zip | 94566-6128
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Country | US
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Telephone | 925-846-9291
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Fax | 925-846-9260
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Authorized Official
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Title or Position | VICE PRES.
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Name | NANCY FURTADO
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Credential |
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Telephone | 925-846-9291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number | RHP00041624
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2471C3401X
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Taxonomy Name | Computed Tomography Radiologic Technologist
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License Number | RHP00041624
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2471C3402X
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Taxonomy Name | Radiography Radiologic Technologist
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License Number | RHP00041624
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License Number State | CA
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