Provider Demographics
NPI:1023112760
Name:VIDAL MEDICAL OFFICE PLC
Entity type:Organization
Organization Name:VIDAL MEDICAL OFFICE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES-VIDAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-423-9699
Mailing Address - Street 1:21300 N JOHN WAYNE PKWY
Mailing Address - Street 2:UNIT 116 BLDG 7
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-8978
Mailing Address - Country:US
Mailing Address - Phone:520-423-9699
Mailing Address - Fax:520-423-9599
Practice Address - Street 1:21300 N JOHN WAYNE PKWY
Practice Address - Street 2:UNIT 116 BLDG 7
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-8979
Practice Address - Country:US
Practice Address - Phone:520-423-9699
Practice Address - Fax:520-423-9599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ313021OtherAHCCCS #
AZ313021OtherAHCCCS #