Individual
DR. IRENA SARAH VIDITO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
300 HILLMONT AVE, VENTURA, CA 93003-1651
(805) 652-6556
Mailing address
800 S VICTORIA AVE, L4615, VCHCA - PHYSICIAN SERVICES, VENTURA, CA 93009-0003
(805) 677-5181
(805) 677-5304
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
TL1160
SC
207R00000X
Internal Medicine Physician
—
NY
207RH0003X
Hematology & Oncology Physician
Primary
20A15672
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
011604
—
SC
01
—
571050553
BCBS OF SOUTH CAROLINA
SC
01
—
P00692297
RR MEDICARE
SC
01
—
TL1160
LISCENSE
SC
Enumeration date
12/13/2006
Last updated
07/21/2022
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