# HOME PORTABLE X-RAY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396920047
- **Authorized official:** MR. CHARLES WM CROUSE CRT (OWNER OPERATOR)
- **Authorized official phone:** (650) 347-1880

## Contact information

- **Practice address:** 30 SO EL CAMINO REAL, SUITE 109, SAN MATEO, CA 94401
- **Practice address phone:** (650) 347-1880
- **Practice address fax:** (650) 342-8379
- **Mailing address:** 801 MAPLE ST, SAN MATEO, CA 94402
- **Mailing address phone:** (650) 703-9701
- **Mailing address fax:** (650) 342-8379

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 335V00000X | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | RHT3605 | CA | Yes |

## Other

- **Enumeration date:** 12/31/2007
- **Last updated:** 12/31/2007