| NPI | 1336008036 |
|---|---|
| Doing Business As | VIDALTIA |
| Entity Type | Organization |
| Authorized Contact | EZECHIEL FENELON CEO 202-802-0082 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| 261QH0100X Clinic/Center, Health Services | |
| 261QI0500X Clinic/Center, Infusion Therapy | |
| 261QP0904X Clinic/Center, Public Health, Federal | |
| 261QP0905X Clinic/Center, Public Health, State or Local | |
| 261QP2300X Clinic/Center, Primary Care | |
| 261QP3300X Clinic/Center, Pain | |
| 261QV0200X Clinic/Center, VA | |
| 261QX0100X Clinic/Center, Occupational Medicine | |
| 281P00000X Chronic Disease Hospital | |
| 302F00000X Exclusive Provider Organization | |
| 302R00000X Health Maintenance Organization | |
| 305R00000X Preferred Provider Organization | |
| 305S00000X Point of Service | |
| Enumeration Date | 2026-01-19 |
| Last Update Date | 2026-01-19 |