Vida Medical, New Jersey, P.C. NJ

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

VIDA MEDICAL, NEW JERSEY, P.C. NJ

Practice address

100 Montgomery St Ste 750
San Francisco, CA 94104-4302

Phone

(845) 721-6214

NPI assigned

Dec 1, 2023

Organization subpart

No

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

Authorized official

Name

Jacqueline Odonnell

Title

Sr. Manager, Compliance

Phone

(845) 721-6214

Specialties & licenses 9

Addresses

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

{
    "created_epoch": "1701388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721520000000",
    "number": "1265208052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MONTGOMERY ST STE 750",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941044302",
            "telephone_number": "845-721-6214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MONTGOMERY ST STE 750",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941044302",
            "telephone_number": "845-721-6214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIDA MEDICAL, NEW JERSEY, P.C. NJ",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-01",
        "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": "SR. MANAGER, COMPLIANCE",
        "authorized_official_telephone_number": "845-721-6214"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Health & Wellness Coach",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria E Huff DC
• Victoria Reyzelman
• Cleopatra Victoria, MFT
• Vida Health, Inc.
• Vida Medical PC
• Vida Medical, P.a. Ka
• Grecya Nadir Odette Vidal Zavala
• Edree Vidal
• Genevieve Vidal
• Michelle Vidal

• Multi-Specialty Clinic/Center in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Multi-Specialty Clinic/Center in California

• 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.