Healthcare Provider Details

I. General information

NPI: 1144585233
Provider Name (Legal Business Name): LUIS FRANCISCO HIDALGO PONCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20801 NW 2ND AVE
MIAMI FL
33169-2103
US

IV. Provider business mailing address

20801 NW 2ND AVE
MIAMI FL
33169-2103
US

V. Phone/Fax

Practice location:
  • Phone: 305-653-1770
  • Fax: 786-725-3453
Mailing address:
  • Phone: 305-653-1770
  • Fax: 786-725-3453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME154255
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: