Provider Demographics
NPI:1407613490
Name:VIDAL, SAIDA CARIDAD
Entity Type:Individual
Prefix:
First Name:SAIDA
Middle Name:CARIDAD
Last Name:VIDAL
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 1:998 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3423
Mailing Address - Country:US
Mailing Address - Phone:786-606-0951
Mailing Address - Fax:
Practice Address - Street 1:8323 NW 12TH ST STE 216
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1840
Practice Address - Country:US
Practice Address - Phone:305-224-1929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1033720106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician