Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 063816 | NJ |
Y | 2080P0204X | Pediatric Emergency Doctor | ME80877 | FL |
NPI | 1053327254 |
---|---|
Provider Name | Jose Vidal |
First Address | Coral Gables, FL 33146 |
Second Address | Coral Gables, FL 33146 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 17/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
279761500 | (05) | FL |
7973403 | (05) | NJ |
C96666 | (02) |