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NPI Code Detail

MEDICARE: DR. HILDA FLORES-VIDAL M.D.

MEDICARE: DR. HILDA FLORES-VIDAL M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist31903AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1819005OTHERAZAHCCCS

General Provider Information

NPI Number : 1376646810
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HILDA FLORES-VIDAL M.D.
Provider Business Mailing Address
First Line : 21300 N JOHN WAYNE PKWY
Second Line : UNIT 116 BLDG 7
City : MARICOPA
State : AZ
Zip : 85139-8978
Country : US
Telephone Number : 520-423-9699
Fax Number : 520-423-9599
Provider Business Practice Location Address
First Line : 21300 N. JOHN WAYNE PKWY
Second Line : UNIT 116 BLDG 7
City : MARICOPA
State : AZ
Zip : 85139-8978
Country : US
Telephone Number : 520-423-9699
Fax Number : 520-423-9599
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2006
Last Update Date : 04/03/2017

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