Elizabeth Ryan Vidovich, LVN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

VN230370 Issued in CA

Practice address

2540 Forest Ave
San Jose, CA 95117-1117

Phone

(408) 642-5039

Fax

(408) 642-5039

NPI assigned

Aug 29, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1377734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377734400000",
    "number": "1033543731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2540 FOREST AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951171117",
            "telephone_number": "408-642-5039",
            "fax_number": "408-642-5039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2540 FOREST AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951171117",
            "telephone_number": "408-642-5039",
            "fax_number": "408-642-5039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIDOVICH",
        "first_name": "ELIZABETH",
        "middle_name": "RYAN",
        "credential": "LVN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-08-29",
        "last_updated": "2013-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "CA",
            "license": "VN230370",
            "primary": true
        },
        {
            "code": "167G00000X",
            "taxonomy_group": "",
            "desc": "Licensed Psychiatric Technician",
            "state": "CA",
            "license": "VN203070",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Joanna Bell Vidrine, M.A.
• Vidya Bobba Dental Group Inc.
• Vidya Bobba, DMD, Inc.
• Brenda Vieira
• Patricia Vielbig, DDS

• Licensed Practical Nurse in San Jose, CA
• Providers in San Jose, CA by specialty
• Licensed Practical Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2013; 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.