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General NPI Number Information
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NPI Number | 1821761784
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Entity Type | Individual
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Provider Name | MONICA MARLENE VIDES
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Gender | Female
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Dates
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Enumeration Date | 07/27/2021
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Last Update Date | 09/07/2022
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Provider Practice Location Address
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Address Line | 2904 PONCE CREST DR
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City | SAINT CLOUD
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State | FL
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Zip | 34772-8955
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Country | US
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Telephone | 689-210-9602
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Fax |
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Provider Business Mailing Address
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Address Line | 2904 PONCE CREST DR
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City | SAINT CLOUD
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State | FL
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Zip | 34772-8955
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Country | US
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Telephone |
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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 | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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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 | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State | FL
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