Individual
LYDIA IVETTE VIDAL-CARDOZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
108 FINNEGAN CT, MYRTLE BEACH, SC 29579-4205
(843) 909-9993
(843) 903-3366
Mailing address
108 FINNEGAN CT, MYRTLE BEACH, SC 29579-4205
(843) 909-9993
(843) 903-3366
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
C0000746
MD
363AM0700X
Medical Physician Assistant
Primary
PA1294
SC
Other
Enumeration date
08/08/2006
Last updated
01/15/2014
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