Provider Demographics
NPI:1588797070
Name:RIVERA-HIDALGO, ZORAIDA (MD)
Entity Type:Individual
Prefix:
First Name:ZORAIDA
Middle Name:
Last Name:RIVERA-HIDALGO
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 1:2647 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4840
Mailing Address - Country:US
Mailing Address - Phone:954-927-7575
Mailing Address - Fax:954-927-5272
Practice Address - Street 1:2647 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4840
Practice Address - Country:US
Practice Address - Phone:954-927-7575
Practice Address - Fax:954-927-5272
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL58462207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056352800Medicaid
FL056352800Medicaid
FLE64656Medicare UPIN
FL65-0272519OtherTIN