Healthcare Provider Details

I. General information

NPI: 1437248630
Provider Name (Legal Business Name): MARTHA G VIDAL MD.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W. COLLEGE STREET M88
LOS ANGELES CA
90012
US

IV. Provider business mailing address

711 W. COLLEGE STREET M88
LOS ANGELES CA
90012
US

V. Phone/Fax

Practice location:
  • Phone: 213-808-1792
  • Fax: 213-680-9427
Mailing address:
  • Phone: 213-808-1792
  • Fax: 213-680-9427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA78069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: