Healthcare Provider Details

I. General information

NPI: 1366494411
Provider Name (Legal Business Name): ALICIA VIDAL-ZAS PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14225 SW 42ND ST
MIAMI FL
33175-6408
US

IV. Provider business mailing address

14225 SW 42ND ST
MIAMI FL
33175-6408
US

V. Phone/Fax

Practice location:
  • Phone: 305-221-8200
  • Fax: 305-221-9800
Mailing address:
  • Phone: 305-221-8200
  • Fax: 305-221-9800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY6481
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: