Active NPI
Lydia Ivette Vidal-Cardozo, PAC
- Medical Physician Assistant
- Myrtle Beach, SC
National Provider Identifier
1174533863
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA1294
- Practice address
- 108 Finnegan CT
Myrtle Beach, SC 29579-4205 - Phone
- (843) 909-9993
- Fax
- (843) 903-3366
- NPI assigned
- Aug 8, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | C0000746 | MD | |
| Medical Physician Assistant | 363AM0700X | PA1294 | SC | Primary |
Addresses
Primary practice location
108 Finnegan CT
Myrtle Beach, SC 29579-4205
Mailing address
108 Finnegan CT
Myrtle Beach, SC 29579-4205
Phone (843) 909-9993
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1294 | SC | MD | Oncology Registered Nurse |
| C0000746 | MD | MD | Family Medicine Physician |
| PA1294 | SC | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389744000000",
"number": "1174533863",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "108 FINNEGAN CT",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295794205",
"telephone_number": "843-909-9993",
"fax_number": "843-903-3366"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "108 FINNEGAN CT",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295794205",
"telephone_number": "843-909-9993",
"fax_number": "843-903-3366"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VIDAL-CARDOZO",
"first_name": "LYDIA",
"middle_name": "IVETTE",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-08",
"last_updated": "2014-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MD",
"license": "C0000746",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "SC",
"license": "PA1294",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Myrtle Beach, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.