Basic Information
| Provider Information | |||||||||
| NPI: | 1447356472 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SADA MATOS | ||||||||
| FirstName: | ANTHONY | ||||||||
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| Credential: | R.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | ED10 CALLE PINO | ||||||||
| Address2: | LOS ALMENDROS | ||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009613404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7873092663 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 AVE LAUREL | ||||||||
| Address2: | SANTA JUANITA | ||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009564816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877875151 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2471C3402X | 989 | PR | Y | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Radiography |
No ID Information.