Healthcare Provider Details

I. General information

NPI: 1912983735
Provider Name (Legal Business Name): VIDA S CAMPBELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VIDA S. ASHRAF M.D.

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 EL CAMINO REAL
PALO ALTO CA
94301-2302
US

IV. Provider business mailing address

2350 W EL CAMINO REAL FL 2
MOUNTAIN VIEW CA
94040-6203
US

V. Phone/Fax

Practice location:
  • Phone: 650-853-2955
  • Fax:
Mailing address:
  • Phone: 415-884-3418
  • Fax: 415-883-8082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberG79049
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberMD00032481
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD0003241
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG79049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: