MEDICARE: ALICIA R VIDAL ZAS PSY D PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY6481	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184704322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALICIA R VIDAL ZAS PSY D PA

Provider Business Mailing Address
First Line	:	14225 SW 42ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-6408
Country	:	US
Telephone Number	:	305-221-8200
Fax Number	:	305-221-9800

Provider Business Practice Location Address
First Line	:	14225 SW 42ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-6408
Country	:	US
Telephone Number	:	305-221-8200
Fax Number	:	305-221-9800

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. ALICIA R VIDAL ZAS
Credential	:	PSY.D.
Telephone Number	:	305-221-8200

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	08/07/2014

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