Provider Demographics
NPI:1972996056
Name:VIDAL-CHAVEZ, RICARDO FRANCISCO
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:FRANCISCO
Last Name:VIDAL-CHAVEZ
Suffix:
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 1:2909 S 91ST ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-3654
Mailing Address - Country:US
Mailing Address - Phone:414-507-5132
Mailing Address - Fax:
Practice Address - Street 1:2909 S 91ST ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-3654
Practice Address - Country:US
Practice Address - Phone:414-507-5132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer