Healthcare Provider Details

I. General information

NPI: 1174538813
Provider Name (Legal Business Name): ANA MARGARITA VIDAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 SW 62ND PL STE PHE
SOUTH MIAMI FL
33143-4806
US

IV. Provider business mailing address

7300 SW 62ND PL STE PHE
SOUTH MIAMI FL
33143-4806
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-6367
  • Fax: 305-662-6370
Mailing address:
  • Phone: 305-662-6367
  • Fax: 305-662-6370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberME88264
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME 88264
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: