Healthcare Provider Details

I. General information

NPI: 1336443001
Provider Name (Legal Business Name): GUY HIDAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S MAIN ST STE 100
ORANGE CA
92868-4568
US

IV. Provider business mailing address

PO BOX 51342
LOS ANGELES CA
90051-5642
US

V. Phone/Fax

Practice location:
  • Phone: 714-512-3914
  • Fax:
Mailing address:
  • Phone: 714-456-7005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberF5641
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: