Individual
JUAN D VIDAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
11460 PINES BLVD, PEMBROKE PINES, FL 33026-4128
(954) 433-4200
Mailing address
6101 BLUE LAGOON DR STE 200, MIAMI, FL 33126-3168
(305) 500-2000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9106281
FL
Other
Enumeration date
11/02/2011
Last updated
03/03/2026
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