Provider Demographics
NPI:1619242807
Name:VIDMAR, ALAINA PHILLIPS (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAINA
Middle Name:PHILLIPS
Last Name:VIDMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 W SUNSET BLVD
Mailing Address - Street 2:DEPARTMENT OF PEDIATRIC ENDOCRINOLOGY
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6062
Mailing Address - Country:US
Mailing Address - Phone:323-361-3385
Mailing Address - Fax:323-361-1360
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:DEPARTMENT OF PEDIATRIC ENDOCRINOLOGY
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-361-3385
Practice Address - Fax:323-361-1360
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1361742080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology