Provider Demographics
NPI:1437556156
Name:MATTHEWS, JOSEPH DANIEL (RDCS, RVT, RDMS, RPH)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DANIEL
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:RDCS, RVT, RDMS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4864
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-0864
Mailing Address - Country:US
Mailing Address - Phone:408-829-6486
Mailing Address - Fax:408-890-4770
Practice Address - Street 1:65 NIELSON ST, 101
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2491
Practice Address - Country:US
Practice Address - Phone:408-829-6486
Practice Address - Fax:408-890-4770
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA719892471S1302X, 2471V0105X, 246X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist Cardiovascular
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGU798AMedicare UPIN