Healthcare Provider Details

I. General information

NPI: 1023112760
Provider Name (Legal Business Name): VIDAL MEDICAL OFFICE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21300 N JOHN WAYNE PKWY UNIT 116 BLDG 7
MARICOPA AZ
85139-8979
US

IV. Provider business mailing address

21300 N JOHN WAYNE PKWY UNIT 116 BLDG 7
MARICOPA AZ
85139-8978
US

V. Phone/Fax

Practice location:
  • Phone: 520-423-9699
  • Fax: 520-423-9599
Mailing address:
  • Phone: 520-423-9699
  • Fax: 520-423-9599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HILDA FLORES-VIDAL
Title or Position: OWNER
Credential: M.D.
Phone: 520-423-9699