Healthcare Provider Details

I. General information

NPI: 1376646810
Provider Name (Legal Business Name): HILDA FLORES-VIDAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21300 N. JOHN WAYNE PKWY UNIT 116 BLDG 7
MARICOPA AZ
85139-8978
US

IV. Provider business mailing address

21300 N JOHN WAYNE PKWY UNIT 116 BLDG 7
MARICOPA AZ
85139-8978
US

V. Phone/Fax

Practice location:
  • Phone: 520-423-9699
  • Fax: 520-423-9599
Mailing address:
  • Phone: 520-423-9699
  • Fax: 520-423-9599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number31903
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: