Organization
ALELI VIDAD MD, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALELI FAVILA VIDAD MD (MD)
(775) 881-8543
Entity
Organization
Contact information
Practice address
501 N. NAVAJO DR, PAGE, AZ 86040
(775) 883-3336
(775) 883-0877
Mailing address
PO BOX 4477, CARSON CITY, NV 89702-4477
(775) 883-3336
(775) 883-0877
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
12435
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1750576245
INDIVIDUAL NPI
NV
Enumeration date
03/06/2012
Last updated
03/06/2012
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