Provider Demographics
NPI:1558817031
Name:VILMA L HIDALGO, MD, INC.
Entity Type:Organization
Organization Name:VILMA L HIDALGO, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VILMA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HIDALGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-855-4577
Mailing Address - Street 1:903 W CENTER ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-7315
Mailing Address - Country:US
Mailing Address - Phone:209-855-4577
Mailing Address - Fax:209-565-8506
Practice Address - Street 1:903 W CENTER ST
Practice Address - Street 2:SUITE 6
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-7315
Practice Address - Country:US
Practice Address - Phone:209-855-4577
Practice Address - Fax:209-565-8506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA914362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty