Provider Demographics
NPI:1629205422
Name:VIDA MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:VIDA MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARMEN
Authorized Official - Middle Name:YEGHIA
Authorized Official - Last Name:NERSECCIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:909-429-8000
Mailing Address - Street 1:16127 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3374
Mailing Address - Country:US
Mailing Address - Phone:909-429-8000
Mailing Address - Fax:909-429-8705
Practice Address - Street 1:16127 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3374
Practice Address - Country:US
Practice Address - Phone:909-429-8000
Practice Address - Fax:909-429-8705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty