Active NPI
Katy De Freites Vidal, M.D.
- General Practice Physician
- Ponce, PR
National Provider Identifier
1376741769
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- PR16652
- Practice address
- Edif Parras Ste 708
Ponce by Pass
Ponce, PR 00717-1321 - Phone
- (787) 812-3792
- Fax
- (787) 812-3794
- NPI assigned
- Jul 6, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | PR16652 | PR | Primary |
Addresses
Primary practice location
Edif Parras Ste 708
Ponce by Pass
Ponce, PR 00717-1321
Mailing address
PO Box 1688
Coamo, PR 00769-1688
Phone (787) 642-6291
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 16652 | Other | PR | PR MEDICAL DOCTOR |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PR16652 | PR | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376741769",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1688",
"city": "COAMO",
"state": "PR",
"postal_code": "007691688",
"telephone_number": "787-642-6291"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "EDIF PARRAS STE 708",
"address_2": "PONCE BY PASS",
"city": "PONCE",
"state": "PR",
"postal_code": "007171321",
"telephone_number": "787-812-3792",
"fax_number": "787-812-3794"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE FREITES VIDAL",
"first_name": "KATY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "PR",
"license": "PR16652",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PR MEDICAL DOCTOR",
"identifier": "16652",
"state": "PR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ponce, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.