Individual
TATIANA VIDAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
300 RICHMOND ST, PROVIDENCE, RI 02903-4222
(401) 430-0125
Mailing address
208 PUTNAM PIKE APT 1, JOHNSTON, RI 02919-1401
(401) 617-3248
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
12/17/2021
Last updated
12/17/2021
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