Provider Demographics
NPI:1063659050
Name:PALM SPRINGS PEDIATRICS PA
Entity Type:Organization
Organization Name:PALM SPRINGS PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUSBERTO
Authorized Official - Middle Name:B
Authorized Official - Last Name:HIDALGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-442-8888
Mailing Address - Street 1:17901 NW 5TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2810
Mailing Address - Country:US
Mailing Address - Phone:954-442-8888
Mailing Address - Fax:954-442-8661
Practice Address - Street 1:17901 NW 5TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2810
Practice Address - Country:US
Practice Address - Phone:954-442-8888
Practice Address - Fax:954-442-8661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty