Individual
ANTONELL VIDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
700 LAWRENCE EXPY, SANTA CLARA, CA 95051-5173
(408) 851-7020
Mailing address
1592 BURRELL CT, SAN JOSE, CA 95126-1608
(408) 891-6262
Taxonomy
Speciality
Code
Description
License number
State
227900000X
Registered Respiratory Therapist
Primary
22032
CA
Other
Enumeration date
11/23/2018
Last updated
11/23/2018
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