NPIMap

Organization Active NPI

Vida Medical of Delaware PA

  • Multi-Specialty Clinic/Center
  • Carson, CA
National Provider Identifier
1003656844
Registry record updated Jul 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
VIDA MEDICAL OF DELAWARE PA
Practice address
20500 Belshaw Ave # Exca1377
Carson, CA 90746-3506
Phone
(415) 989-1017
NPI assigned
May 29, 2024
Last updated
Jul 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jacqueline Odonnell
Title
Director, Qa and Compliance
Phone
(415) 989-1017

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary
Nurse Practitioner 363L00000X NU
Mental Health Counselor 101YM0800X NU
Psychologist 103T00000X NU
Social Worker 104100000X NU
Registered Dietitian 133V00000X NU
Family Medicine Physician 207Q00000X NU
Health & Wellness Coach 171400000X NU

Addresses

Primary practice location

20500 Belshaw Ave # Exca1377
Carson, CA 90746-3506

Mailing address

20500 Belshaw Ave # Exca1377
Carson, CA 90746-3506

National Provider Directory

National Provider Directory

Locations

20500 Belshaw Ave
#1377
Carson, CA 90746
Phone (415) 989-1017

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1716940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721520000000",
    "number": "1003656844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20500 BELSHAW AVE # EXCA1377",
            "city": "CARSON",
            "state": "CA",
            "postal_code": "907463506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20500 BELSHAW AVE # EXCA1377",
            "city": "CARSON",
            "state": "CA",
            "postal_code": "907463506",
            "telephone_number": "415-989-1017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIDA MEDICAL OF DELAWARE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-29",
        "last_updated": "2024-07-21",
        "certification_date": "2024-07-21",
        "status": "A",
        "authorized_official_last_name": "ODONNELL",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "DIRECTOR, QA AND COMPLIANCE",
        "authorized_official_telephone_number": "415-989-1017"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carson, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.