Healthcare Provider Details

I. General information

NPI: 1366936866
Provider Name (Legal Business Name): CRISTABEL ROBLES HIDALGO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S PINE ISLAND RD STE 350
PLANTATION FL
33324-4409
US

IV. Provider business mailing address

6400 SHAFER CT STE 700
ROSEMONT IL
60018-4989
US

V. Phone/Fax

Practice location:
  • Phone: 954-624-7900
  • Fax:
Mailing address:
  • Phone: 346-376-1702
  • Fax: 224-532-2780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME155940
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberME155940
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: