Provider Demographics
NPI:1497068027
Name:SONOLAB IMAGING SOLUTIONS, LLC
Entity Type:Organization
Organization Name:SONOLAB IMAGING SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDDIE
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:MATEO
Authorized Official - Suffix:JR
Authorized Official - Credentials:RDMS, RVT, RT(R)
Authorized Official - Phone:956-792-0755
Mailing Address - Street 1:PO BOX 1123
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-0012
Mailing Address - Country:US
Mailing Address - Phone:956-792-0755
Mailing Address - Fax:956-440-8484
Practice Address - Street 1:808 W ARROYO PARK LN APT D
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8462
Practice Address - Country:US
Practice Address - Phone:956-792-0755
Practice Address - Fax:956-440-8484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-25
Last Update Date:2010-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80226261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile