Provider Demographics
NPI:1750688875
Name:VAN VIDA, KATREENA (RDMS)
Entity type:Individual
Prefix:
First Name:KATREENA
Middle Name:
Last Name:VAN VIDA
Suffix:
Gender:F
Credentials:RDMS
Other - Prefix:
Other - First Name:KATHARINA
Other - Middle Name:
Other - Last Name:VAN HOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:429 1ST ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-1827
Mailing Address - Country:US
Mailing Address - Phone:202-701-3233
Mailing Address - Fax:
Practice Address - Street 1:429 1ST ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-1827
Practice Address - Country:US
Practice Address - Phone:202-701-3233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography