Healthcare Provider Details

I. General information

NPI: 1790377232
Provider Name (Legal Business Name): ERICA VIDANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 INDUSTRIAL BLVD # 600
WEST SACRAMENTO CA
95691-3496
US

IV. Provider business mailing address

1555 MERCY ST APT 3
MOUNTAIN VIEW CA
94041-1856
US

V. Phone/Fax

Practice location:
  • Phone: 916-542-9514
  • Fax:
Mailing address:
  • Phone: 714-814-7142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMF162418
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: