Provider Demographics
NPI:1457187411
Name:VIDAL, GABRIEL ENRIQUE
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:ENRIQUE
Last Name:VIDAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8183 BARLOW RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8502
Mailing Address - Country:US
Mailing Address - Phone:614-900-0901
Mailing Address - Fax:
Practice Address - Street 1:8183 BARLOW RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8502
Practice Address - Country:US
Practice Address - Phone:614-900-0901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker