Provider Demographics
NPI:1831453976
Name:VIDALES, ALEJANDRINA GUZMAN (MD)
Entity type:Individual
Prefix:DR
First Name:ALEJANDRINA
Middle Name:GUZMAN
Last Name:VIDALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALEJANDRINA
Other - Middle Name:
Other - Last Name:GUZMAN BONILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3701 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3611
Mailing Address - Country:US
Mailing Address - Phone:303-761-1977
Mailing Address - Fax:303-761-2787
Practice Address - Street 1:7495 W 29TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-8002
Practice Address - Country:US
Practice Address - Phone:303-239-9964
Practice Address - Fax:303-237-4343
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL-4533207Q00000X
CODR.0055693207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine