Provider Demographics
NPI:1922677541
Name:HIDALGO, JESSICA PONCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:PONCE
Last Name:HIDALGO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1546 UNIVERSITY VLG
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-3524
Mailing Address - Country:US
Mailing Address - Phone:323-474-1037
Mailing Address - Fax:
Practice Address - Street 1:5063 S COTTONWOOD ST STE 100
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6772
Practice Address - Country:US
Practice Address - Phone:323-474-1037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS