Provider Demographics
NPI:1013465095
Name:HIDALGO, JUAN CARLOS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:CARLOS
Last Name:HIDALGO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6200 SUNSET DR STE 302
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4829
Mailing Address - Country:US
Mailing Address - Phone:786-888-8820
Mailing Address - Fax:786-591-6025
Practice Address - Street 1:2801 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5727
Practice Address - Country:US
Practice Address - Phone:786-595-3400
Practice Address - Fax:844-466-6829
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110195363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant