Individual
DR. CHAUNTELLE VIDINHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
3269 N STOCKTON HILL RD, KINGMAN, AZ 86409-3619
(928) 757-2101
Mailing address
1815 N STOCKTON HILL RD, KINGMAN, AZ 86401-4667
(928) 753-9629
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
008625
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/11/2017
Last updated
03/30/2021
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