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Organization
LISA D. VIDATO, M.D., INC.
Active
Organization
LISA D. VIDATO, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA D. VIDATO M.D. (OWNER)
(310) 829-8202
Entity
Organization
Contact information
Practice address
1328 22ND ST, SANTA MONICA, CA 90404-2032
(310) 829-8202
Mailing address
11999 SAN VICENTE BLVD, #440, LOS ANGELES, CA 90049-5131
(310) 471-5852
(310) 471-3958
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G68685
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G686850
—
CA
Enumeration date
08/31/2006
Last updated
03/31/2008
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