Healthcare Provider Details

I. General information

NPI: 1518782861
Provider Name (Legal Business Name): DENISE HIDALGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 BOULEVARD DEL REY DAVID
NOGALES AZ
85621-9651
US

IV. Provider business mailing address

368 RIO RICO DR
RIO RICO AZ
85648-3538
US

V. Phone/Fax

Practice location:
  • Phone: 520-377-2646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number280386
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: