Provider Demographics
NPI:1780079582
Name:VASCONEZ, JOSE A (RT(R)(ARRT))
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:A
Last Name:VASCONEZ
Suffix:
Gender:M
Credentials:RT(R)(ARRT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 S HARLAN AVE
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-4215
Mailing Address - Country:US
Mailing Address - Phone:310-989-1677
Mailing Address - Fax:
Practice Address - Street 1:1029 S HARLAN AVE
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-4215
Practice Address - Country:US
Practice Address - Phone:310-989-1677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHF00098064247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist