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General NPI Number Information
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NPI Number | 1053209312
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Entity Type | Individual
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Provider Name | ELENA VIDES
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Gender | Female
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Dates
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Enumeration Date | 06/25/2025
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 38345 30TH ST E STE C2
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City | PALMDALE
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State | CA
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Zip | 93550-4982
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Country | US
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Telephone | 661-461-7465
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Fax |
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Provider Business Mailing Address
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Address Line | 43618 EASY ST
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City | LANCASTER
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State | CA
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Zip | 93535-5600
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Country | US
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Telephone | 661-998-6567
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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