Provider Demographics
NPI:1821847369
Name:VIDAD, NOELIKA ANN RAQUEL (LPT)
Entity type:Individual
Prefix:
First Name:NOELIKA
Middle Name:ANN RAQUEL
Last Name:VIDAD
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:NOELIKA
Other - Middle Name:ANN
Other - Last Name:RAQUEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPT
Mailing Address - Street 1:32164 BIG CREEK CT
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-7742
Mailing Address - Country:US
Mailing Address - Phone:559-350-4761
Mailing Address - Fax:
Practice Address - Street 1:1393 BAILEY ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5922
Practice Address - Country:US
Practice Address - Phone:559-582-4481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40813167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician