Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | DC-32366 | CA |
Y | 213ER0200X | Radiology | DC-32366 | CA |
NPI | 1013485911 |
---|---|
Provider Name | Dr. Matthew Skalski |
First Address | San Jose, CA 95134-1617 |
Second Address | San Jose, CA 95134-1617 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2018 |
Last Update Date | 08/11/2018 |