MEDICARE: ERICA VIDANO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	LMF162418	CA

General Provider Information

NPI Number	:	1790377232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA VIDANO

Provider Business Mailing Address
First Line	:	1555 MERCY ST APT 3
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94041-1856
Country	:	US
Telephone Number	:	714-814-7142
Fax Number	:

Provider Business Practice Location Address
First Line	:	3960 INDUSTRIAL BLVD # 600
Second Line	:
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-3496
Country	:	US
Telephone Number	:	916-542-9514
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2021
Last Update Date	:	04/13/2026

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