Provider Demographics
NPI:1770576357
Name:HIDALGO, ROBERT DANIEL JR (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DANIEL
Last Name:HIDALGO
Suffix:JR
Gender:M
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:PO BOX 2844
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92628-2844
Mailing Address - Country:US
Mailing Address - Phone:714-965-6611
Mailing Address - Fax:714-965-6690
Practice Address - Street 1:18207 E MCDURMOTT
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-4770
Practice Address - Country:US
Practice Address - Phone:949-553-0010
Practice Address - Fax:949-553-0098
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72815174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist