Provider Demographics
NPI:1033952296
Name:VIDAL, BETSABE
Entity type:Individual
Prefix:
First Name:BETSABE
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 1:2637 GALLIANO CIR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-1515
Mailing Address - Country:US
Mailing Address - Phone:407-218-0375
Mailing Address - Fax:
Practice Address - Street 1:2637 GALLIANO CIR
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-1515
Practice Address - Country:US
Practice Address - Phone:407-218-1041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No374U00000XNursing Service Related ProvidersHome Health Aide