Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 30207 | AZ |
N | 207VG0400X | Gynecologist | 30207 | AZ |
NPI | 1194717991 |
---|---|
Provider Name | Dr. Felipe L.g. Videla |
First Address | Phoenix, AZ 85016-1302 |
Second Address | Phoenix, AZ 85016-1302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2005 |
Last Update Date | 14/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
709438 | (05) | AZ |
7802344 | AETNA (01) | AZ |
AZ0718260 | BLUE CROSS BLUE SHIELD (01) | AZ |
G47492 | (02) | AZ |