Provider Demographics
NPI:1689297186
Name:VIDAL, MARGARITA
Entity Type:Individual
Prefix:
First Name:MARGARITA
Middle Name:
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:MILITARY MEDICAL CENTER
Mailing Address - Street 2:3551 ROGER BROOKE DRI
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-3122
Mailing Address - Country:US
Mailing Address - Phone:714-360-3451
Mailing Address - Fax:
Practice Address - Street 1:SAN ANTONIO MILITARY MEDICAL CENTER
Practice Address - Street 2:3551 ROGER BROOKE DR.
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78234
Practice Address - Country:US
Practice Address - Phone:210-359-6150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-19
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0151471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical