Healthcare Provider Details

I. General information

NPI: 1235637638
Provider Name (Legal Business Name): JIDALGO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6241 N DIXIE HWY FL 2
FORT LAUDERDALE FL
33334-3620
US

IV. Provider business mailing address

6241 N DIXIE HWY FL 2
FORT LAUDERDALE FL
33334-3620
US

V. Phone/Fax

Practice location:
  • Phone: 954-990-0967
  • Fax: 954-990-0967
Mailing address:
  • Phone: 954-990-0967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: SANDRA NADAL
Title or Position: OWNER
Credential:
Phone: 954-990-0967