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Individual

ELIZABETH RYAN VIDOVICH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LVN

Contact information

Practice address
2540 FOREST AVE, SAN JOSE, CA 95117-1117
(408) 642-5039
(408) 642-5039
Mailing address
2540 FOREST AVE, SAN JOSE, CA 95117-1117
(408) 642-5039
(408) 642-5039

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CA
164W00000X
Licensed Practical Nurse
Primary
VN230370
CA
167G00000X
Licensed Psychiatric Technician
VN203070
CA

Other

Enumeration date
08/29/2013
Last updated
08/29/2013
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