Provider Demographics
NPI:1376646810
Name:FLORES-VIDAL, HILDA (MD)
Entity Type:Individual
Prefix:DR
First Name:HILDA
Middle Name:
Last Name:FLORES-VIDAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21300 N JOHN WAYNE PKWY
Mailing Address - Street 2:UNIT 116 BLDG 7
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-8978
Mailing Address - Country:US
Mailing Address - Phone:520-423-9699
Mailing Address - Fax:520-423-9599
Practice Address - Street 1:21300 N. JOHN WAYNE PKWY
Practice Address - Street 2:UNIT 116 BLDG 7
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-8978
Practice Address - Country:US
Practice Address - Phone:520-423-9699
Practice Address - Fax:520-423-9599
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31903174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ819005OtherAHCCCS
H98509Medicare UPIN