Provider Demographics
NPI:1376918326
Name:HIDALGO, GILBERT
Entity Type:Individual
Prefix:MR
First Name:GILBERT
Middle Name:
Last Name:HIDALGO
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 1:2000 W COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 202-C
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3073
Mailing Address - Country:US
Mailing Address - Phone:954-202-7822
Mailing Address - Fax:954-202-7821
Practice Address - Street 1:2000 W COMMERCIAL BLVD
Practice Address - Street 2:SUITE 202-C
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3073
Practice Address - Country:US
Practice Address - Phone:954-202-7822
Practice Address - Fax:954-202-7821
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211354251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL651126292Medicaid
FL691528100Medicaid