Provider Demographics
NPI:1497099030
Name:VIDINHAR, KIRSTEN BRIELLE
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:BRIELLE
Last Name:VIDINHAR
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 1:821 N MOJAVE RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-2407
Mailing Address - Country:US
Mailing Address - Phone:702-642-7070
Mailing Address - Fax:702-649-3906
Practice Address - Street 1:821 N MOJAVE RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-2407
Practice Address - Country:US
Practice Address - Phone:702-642-7070
Practice Address - Fax:702-649-3906
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner