Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days.
Organization
VIDALTIA CORP.
Active
Organization
VIDALTIA CORP.
Active
Other names
Vidaltia
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EZECHIEL FENELON (CEO)
(202) 802-0082
Entity
Organization
Contact information
Practice address
6456 NW 5TH WAY, FORT LAUDERDALE, FL 33309-6112
(202) 802-0082
Mailing address
6456 NW 5TH WAY, FORT LAUDERDALE, FL 33309-6112
(202) 802-0082
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QI0500X
Infusion Therapy Clinic/Center
—
—
261QP0904X
Federal Public Health Clinic/Center
—
—
261QP0905X
State or Local Public Health Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QP3300X
Pain Clinic/Center
—
—
261QV0200X
VA Clinic/Center
—
—
261QX0100X
Occupational Medicine Clinic/Center
—
—
281P00000X
Chronic Disease Hospital
—
—
302F00000X
Exclusive Provider Organization
—
—
302R00000X
Health Maintenance Organization
—
—
305R00000X
Preferred Provider Organization
—
—
305S00000X
Point of Service
—
—
Other
Enumeration date
01/19/2026
Last updated
05/26/2026
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up