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Organization
HOME PORTABLE X-RAY
Active
Organization
HOME PORTABLE X-RAY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES WM CROUSE CRT (OWNER OPERATOR)
(650) 347-1880
Entity
Organization
Contact information
Practice address
30 SO EL CAMINO REAL, SUITE 109, SAN MATEO, CA 94401
(650) 347-1880
(650) 342-8379
Mailing address
801 MAPLE ST, SAN MATEO, CA 94402
(650) 703-9701
(650) 342-8379
Taxonomy
Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
RHT3605
CA
Other
Enumeration date
12/31/2007
Last updated
12/31/2007
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