Provider Demographics
NPI:1578821575
Name:VIDANA, DONALD (RCP, RRT, NPS)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:VIDANA
Suffix:
Gender:M
Credentials:RCP, RRT, NPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6170 WINTERBERRY PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-9098
Mailing Address - Country:US
Mailing Address - Phone:951-897-7972
Mailing Address - Fax:
Practice Address - Street 1:6170 WINTERBERRY PL
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-9098
Practice Address - Country:US
Practice Address - Phone:951-897-7972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13993227800000X
CA40763227900000X
CA2279P3900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
No227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
No2279P3900XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredNeonatal/Pediatrics