Provider Demographics
NPI:1417252792
Name:VIDRIO, JOSE MANUEL JR
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:MANUEL
Last Name:VIDRIO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6323 FLORA AVE
Mailing Address - Street 2:APT. C
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201
Mailing Address - Country:US
Mailing Address - Phone:323-620-9553
Mailing Address - Fax:
Practice Address - Street 1:6323 FLORA AVE
Practice Address - Street 2:APT. C
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-1250
Practice Address - Country:US
Practice Address - Phone:323-620-9553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health