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General NPI Number Information
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NPI Number | 1497068027
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Entity Type | Organization
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Legal Business Name | SONOLAB IMAGING SOLUTIONS, LLC
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Dates
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Enumeration Date | 07/25/2010
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Last Update Date | 07/25/2010
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Provider Practice Location Address
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Address Line | 808 W ARROYO PARK LN APT D
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City | HARLINGEN
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State | TX
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Zip | 78550-8462
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Country | US
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Telephone | 956-792-0755
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Fax | 956-440-8484
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Provider Business Mailing Address
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Address Line | PO BOX 1123
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City | SAN BENITO
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State | TX
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Zip | 78586-0012
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Country | US
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Telephone | 956-792-0755
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Fax | 956-440-8484
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. FREDDIE DANIEL MATEO JR.
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Credential | RDMS, RVT, RT(R)
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Telephone | 956-792-0755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number | 80226
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License Number State | TX
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