Individual
CONCEPCION VIDAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10650 W STATE ROAD 84, DAVIE, FL 33324-4235
(954) 634-3636
Mailing address
19145 SW 25TH CT, MIRAMAR, FL 33029-2465
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102003700
—
FL
Enumeration date
12/28/2010
Last updated
10/18/2019
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