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NPI Code Detail

MEDICARE: MARTHA G VIDAL MD.

MEDICARE: MARTHA G VIDAL MD.
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
1207V00000XObstetrics & Gynecology PhysicianA78069CA

Other Identifiers

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

General Provider Information

NPI Number : 1437248630
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTHA G VIDAL MD.
Provider Business Mailing Address
First Line : 1601 N SEPULVEDA BLVD # 400
Second Line :
City : MANHATTAN BEACH
State : CA
Zip : 90266-5111
Country : US
Telephone Number : 323-755-5500
Fax Number : 323-755-5522
Provider Business Practice Location Address
First Line : 11502 S VERMONT AVE STE B
Second Line :
City : LOS ANGELES
State : CA
Zip : 90044-6522
Country : US
Telephone Number : 323-755-5500
Fax Number : 323-755-5522
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 03/26/2014

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Directions to “ MARTHA G VIDAL MD.” Practice Location

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