Provider Demographics
NPI:1912071481
Name:GONZALEZ HIDALGO, HAYDEE (MD)
Entity Type:Individual
Prefix:
First Name:HAYDEE
Middle Name:
Last Name:GONZALEZ 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 1:11480 BROOSHIRE AVE SUITE 309
Mailing Address - Street 2:
Mailing Address - City:DWONEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5025
Mailing Address - Country:US
Mailing Address - Phone:562-869-1201
Mailing Address - Fax:562-869-1281
Practice Address - Street 1:11480 BROOKSHIRE AVE STE 309
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5025
Practice Address - Country:US
Practice Address - Phone:562-869-1201
Practice Address - Fax:562-869-1281
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6538207RH0003X
CAG155495207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE10357Medicare UPIN
PR29201Medicare ID - Type UnspecifiedPROVIDER NUMBER