Individual
DR. AILEEN MICHELLE DECIERDO VIDAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1215 SANTA FE ST, CORPUS CHRISTI, TX 78404-2338
(361) 884-9900
(361) 884-9903
Mailing address
1521 S STAPLES ST STE 300, CORPUS CHRISTI, TX 78404-3150
(361) 694-1498
(361) 694-1499
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
P0682
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
257795YLPS
WELLMED PTAN
TX
05
—
286456302
—
TX
Enumeration date
02/09/2011
Last updated
03/28/2023
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