Provider Demographics
NPI:1396703179
Name:VALLEY RADIOLOGY MEDICAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:VALLEY RADIOLOGY MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATSUMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-244-2100
Mailing Address - Street 1:2281 PARAGON DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-1307
Mailing Address - Country:US
Mailing Address - Phone:408-961-2649
Mailing Address - Fax:408-244-6596
Practice Address - Street 1:2281 PARAGON DR
Practice Address - Street 2:SUITE 400
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-1307
Practice Address - Country:US
Practice Address - Phone:408-961-2649
Practice Address - Fax:408-244-6596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0081146Medicaid
CAGR008114EMedicaid
CAGR0081148Medicaid
CAGR0081141Medicaid
CAGR0081142Medicaid
CAGR0081140Medicaid
CAGR0081145Medicaid
CAGR008114AMedicaid
CAGR0081146Medicaid
CAZZZ13854ZMedicare PIN
CAZZZ13849ZMedicare PIN
CAZZZ14743ZMedicare PIN
CAZZZ13852ZMedicare PIN
CAGR0081148Medicaid
CAGR0081142Medicaid
CAGR0081141Medicaid
CAZZZ13851ZMedicare PIN