SANDRA ELIZABETH VIDAL


Address: 830 S Fairfax Ave Apt 2, Los Angeles, CA 90036-4467
Phone: 3235709108

SANDRA ELIZABETH VIDAL (NPI# 1881713014) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1881713014
Entity Type Individual
Full Name SANDRA ELIZABETH VIDAL
Practice Address 830 S Fairfax Ave Apt 2
Los Angeles
CA 90036-4467
Practice Telephone 3235709108
Mailing Telephone 3235709108
Enumeration Date 2007-03-28
Last Update Date 2013-05-16
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 103TC0700X Psychologist
Specialization: Clinical
PSY23083 CA Behavioral Health & Social Service Providers

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Office Location

Street Address 830 S FAIRFAX AVE APT 2
City LOS ANGELES
State CA
Zip Code 90036-4467

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Taxonomy Information

Taxonomy Code 103TC0700X
Grouping Behavioral Health & Social Service Providers
Classification Psychologist
Specialization Clinical

Taxonomy Definition

Definition to come...

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Competitor

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City LOS ANGELES
Zip Code 90036

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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