Individual
DR. KATY DE FREITES VIDAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
EDIF PARRAS STE 708, PONCE BY PASS, PONCE, PR 00717-1321
(787) 812-3792
(787) 812-3794
Mailing address
PO BOX 1688, COAMO, PR 00769-1688
(787) 642-6291
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
PR16652
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16652
PR MEDICAL DOCTOR
PR
Enumeration date
07/06/2007
Last updated
07/08/2007
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