Individual
MARC M VIDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
3325 SENN RD, SUITE 7 BLDG 55, SAN DIEGO, CA 92136-5029
(619) 556-3662
Mailing address
3325 SENN RD, SUITE 7 BLDG 55, SAN DIEGO, CA 92136-5029
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
12/02/2008
Last updated
12/02/2008
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