Provider Demographics
NPI:1366024226
Name:VIDAFUL MEDICINE
Entity Type:Organization
Organization Name:VIDAFUL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SORGE
Authorized Official - Suffix:
Authorized Official - Credentials:NMD
Authorized Official - Phone:484-588-5355
Mailing Address - Street 1:7955 AIRPORT RD N STE 101
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-1794
Mailing Address - Country:US
Mailing Address - Phone:484-588-5355
Mailing Address - Fax:484-588-5354
Practice Address - Street 1:7955 AIRPORT RD N STE 101
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-1794
Practice Address - Country:US
Practice Address - Phone:484-588-5355
Practice Address - Fax:484-588-5354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service