Individual
ALYSSA VIDAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
3989 W STETSON AVE STE 202, HEMET, CA 92545-9697
(951) 652-3558
Mailing address
3660 PARK SIERRA DR STE 203, RIVERSIDE, CA 92505-3071
(951) 687-3400
(951) 687-7630
Taxonomy
Speciality
Code
Description
License number
State
163WD1100X
Peritoneal Dialysis Registered Nurse
95148321
CA
163WR0400X
Rehabilitation Registered Nurse
95148321
CA
363L00000X
Nurse Practitioner
Primary
95022142
CA
Other
Enumeration date
10/23/2018
Last updated
05/05/2023
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