Organization
VIDA MEDICAL OF DELAWARE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE ODONNELL (DIRECTOR, QA AND COMPLIANCE)
(415) 989-1017
Entity
Organization
Contact information
Practice address
20500 BELSHAW AVE # EXCA1377, CARSON, CA 90746-3506
(415) 989-1017
Mailing address
20500 BELSHAW AVE # EXCA1377, CARSON, CA 90746-3506
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
—
—
104100000X
Social Worker
—
—
133V00000X
Registered Dietitian
—
—
171400000X
Health & Wellness Coach
—
—
207Q00000X
Family Medicine Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
05/29/2024
Last updated
07/21/2024
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