Provider Demographics
NPI:1821785957
Name:MATEOS SALLES, EMILIANO (BS)
Entity Type:Individual
Prefix:
First Name:EMILIANO
Middle Name:
Last Name:MATEOS SALLES
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7887 E BELLEVIEW AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80111-6077
Mailing Address - Country:US
Mailing Address - Phone:720-287-3093
Mailing Address - Fax:
Practice Address - Street 1:7887 E BELLEVIEW AVE STE 500
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80111-6077
Practice Address - Country:US
Practice Address - Phone:720-287-3093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic