Healthcare Provider Details

I. General information

NPI: 1982914321
Provider Name (Legal Business Name): ANGEL F VIDAL MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11880 BIRD RD SUITE 202
MIAMI FL
33175-3584
US

IV. Provider business mailing address

11880 BIRD RD SUITE 202
MIAMI FL
33175-3584
US

V. Phone/Fax

Practice location:
  • Phone: 305-552-7020
  • Fax: 305-552-7006
Mailing address:
  • Phone: 305-552-7020
  • Fax: 305-552-7006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANGEL F VIDAL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-552-7020