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Individual

IRMA LETICIA VIDALES

Active
Sole proprietor
No

Provider details

NPI number
Gender
X

Contact information

Practice address
17053 FOOTHILL BLVD, FONTANA, CA 92335-3574
(909) 347-1341
Mailing address
303 E VANDERBILT WAY, SAN BERNARDINO, CA 92415-0026
(888) 743-1478

Taxonomy

Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary

Other

Enumeration date
04/08/2025
Last updated
04/08/2025
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