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General NPI Number Information
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NPI Number | 1417965609
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Entity Type | Individual
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Provider Name | VIDA R ISIP P.T.
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Gender | Female
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3851 S SOTO ST
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City | VERNON
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State | CA
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Zip | 90058-1718
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Country | US
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Telephone | 323-585-7162
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Fax | 323-282-4002
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Provider Business Mailing Address
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Address Line | 9432 HILLVIEW RD
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City | ANAHEIM
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State | CA
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Zip | 92804-2340
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Country | US
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Telephone | 714-797-8329
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT16044
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License Number State | CA
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