| The Vidal Womans Medical Clinic Inc | |
|
11502 S Vermont Ave Ste B Los Angeles CA 90044-6522 | |
| (323) 755-5500 | |
| (323) 755-5522 |
| Full Name | The Vidal Womans Medical Clinic Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 11502 S Vermont Ave Ste B, Los Angeles, California |
| Authorized Official Name and Position | Martha G. Vidal (PRESIDENT) |
| Authorized Official Contact | 3237555500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Vidal Womans Medical Clinic Inc 1601 N Sepulveda Blvd # 400 Manhattan Beach CA 90266-5111 Ph: (323) 755-5500 | The Vidal Womans Medical Clinic Inc 11502 S Vermont Ave Ste B Los Angeles CA 90044-6522 Ph: (323) 755-5500 |
| NPI Number | 1326133687 |
|---|---|
| Provider Enumeration Date | 10/04/2006 |
| Last Update Date | 04/18/2023 |
| Medicare PECOS PAC ID | 5395100341 |
|---|---|
| Medicare Enrollment ID | O20230427000838 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326133687 | NPI | - | NPPES |
| 00A780690 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Martha Gonzalez De Vidal |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1437248630 PECOS PAC ID: 6406211358 Enrollment ID: I20230427001382 |
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