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NPI Code Detail

MEDICARE: MICHAEL VIDETTO

MEDICARE: MICHAEL VIDETTO
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
1225C00000XRehabilitation Counselor

General Provider Information

NPI Number : 1821346164
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL VIDETTO
Provider Business Mailing Address
First Line : 3900 W CHARLESTON BLVD STE 170
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1682
Country : US
Telephone Number : 702-453-4673
Fax Number : 702-453-2673
Provider Business Practice Location Address
First Line : 3900 W CHARLESTON BLVD STE 170
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1682
Country : US
Telephone Number : 702-453-4673
Fax Number : 702-453-2673
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2012
Last Update Date : 08/16/2012

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Directions to “ MICHAEL VIDETTO ” Practice Location

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