Provider Demographics
NPI:1235637638
Name:JIDALGO INC
Entity Type:Organization
Organization Name:JIDALGO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:NADAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-990-0967
Mailing Address - Street 1:6241 N DIXIE HWY FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3620
Mailing Address - Country:US
Mailing Address - Phone:954-990-0967
Mailing Address - Fax:
Practice Address - Street 1:6241 N DIXIE HWY FL 2
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334-3620
Practice Address - Country:US
Practice Address - Phone:954-990-0967
Practice Address - Fax:954-990-0967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty