Provider Demographics
NPI:1144585233
Name:HIDALGO PONCE, LUIS FRANCISCO (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:FRANCISCO
Last Name:HIDALGO PONCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20801 NW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2103
Mailing Address - Country:US
Mailing Address - Phone:305-653-1770
Mailing Address - Fax:786-725-3453
Practice Address - Street 1:20801 NW 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-2103
Practice Address - Country:US
Practice Address - Phone:305-653-1770
Practice Address - Fax:786-725-3453
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA390200000X
FLME154255207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program