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Individual
MS. VIDA VICKERS
Active
Individual
MS. VIDA VICKERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA20543
CA
Other
Enumeration date
12/31/2010
Last updated
12/31/2010
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