Healthcare Provider Details

I. General information

NPI: 1457187411
Provider Name (Legal Business Name): GABRIEL ENRIQUE VIDAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8183 BARLOW RD
WESTERVILLE OH
43081-8502
US

IV. Provider business mailing address

8183 BARLOW RD
WESTERVILLE OH
43081-8502
US

V. Phone/Fax

Practice location:
  • Phone: 614-900-0901
  • Fax:
Mailing address:
  • Phone: 614-900-0901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: