Provider Demographics
NPI:1346514585
Name:ALELI VIDAD MD, INC
Entity Type:Organization
Organization Name:ALELI VIDAD MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ALELI
Authorized Official - Middle Name:FAVILA
Authorized Official - Last Name:VIDAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-881-8543
Mailing Address - Street 1:PO BOX 4477
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-4477
Mailing Address - Country:US
Mailing Address - Phone:775-883-3336
Mailing Address - Fax:775-883-0877
Practice Address - Street 1:501 N. NAVAJO DR
Practice Address - Street 2:
Practice Address - City:PAGE
Practice Address - State:AZ
Practice Address - Zip Code:86040
Practice Address - Country:US
Practice Address - Phone:775-883-3336
Practice Address - Fax:775-883-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12435174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1750576245OtherINDIVIDUAL NPI