Provider Demographics
NPI:1518167774
Name:MATTESON, WILLIAM B (RT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:MATTESON
Suffix:
Gender:M
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 S YORKTOWN ST
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-5144
Mailing Address - Country:US
Mailing Address - Phone:408-370-9080
Mailing Address - Fax:
Practice Address - Street 1:928 S YORKTOWN ST
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-5144
Practice Address - Country:US
Practice Address - Phone:408-370-9080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHF78992247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA340660OtherTHE AMERICAN REGISTRY OF