MEDICARE: DANIEL VIDAL

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	106S00000X	Behavior Technician	BACB1567007	FL

General Provider Information

NPI Number	:	1194658039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL VIDAL

Provider Business Mailing Address
First Line	:	522 9TH ST W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34205-7700
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	522 9TH ST W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34205-7700
Country	:	US
Telephone Number	:	855-444-5664
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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Directions to “ DANIEL VIDAL ” Practice Location

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