Provider Demographics
NPI:1215418801
Name:VIDES, ARACELI B
Entity Type:Individual
Prefix:
First Name:ARACELI
Middle Name:B
Last Name:VIDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15769 PATRICIA ST
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-4667
Mailing Address - Country:US
Mailing Address - Phone:951-956-3169
Mailing Address - Fax:
Practice Address - Street 1:15769 PATRICIA ST
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92551-4667
Practice Address - Country:US
Practice Address - Phone:951-956-3169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant