MEDICARE: SKILLTECH DX INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	246XS1301X	Sonography Specialist/Technologist Cardiovascular
2	246ZE0600X	Electroneurodiagnostic Specialist/Technologist
3	246Z00000X	Other Specialist/Technologist

General Provider Information

NPI Number	:	1144649880
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKILLTECH DX INC

Provider Business Mailing Address
First Line	:	8500 VAL VERDE DR
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91304-2135
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8500 VAL VERDE DR
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91304-2135
Country	:	US
Telephone Number	:	818-986-8800
Fax Number	:	818-986-8801

Authorized Official
Title or Position	:	CEO
Name	:	JONATHAN YAKER
Credential	:
Telephone Number	:	800-967-3309

Provider Enumeration Date	:	04/09/2014
Last Update Date	:	07/22/2014

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