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NPI Code Detail

MEDICARE: AYLEEN VIDAL

MEDICARE: AYLEEN 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1265172415
Entity Type Code : Individual
Provider Name (Legal Business Name) : AYLEEN VIDAL
Provider Business Mailing Address
First Line : PO BOX 8267
Second Line :
City : PASADENA
State : CA
Zip : 91109-8267
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6910 S HIGHLAND DR STE 1
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84121-3061
Country : US
Telephone Number : 801-935-4171
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2022
Last Update Date : 03/29/2022

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Directions to “ AYLEEN VIDAL ” Practice Location

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