Healthcare Provider Details

I. General information

NPI: 1871031393
Provider Name (Legal Business Name): TARPON SPRINGS PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 E BOYER ST
TARPON SPRINGS FL
34689-5501
US

IV. Provider business mailing address

1007 E BOYER ST
TARPON SPRINGS FL
34689-5501
US

V. Phone/Fax

Practice location:
  • Phone: 727-772-5982
  • Fax: 727-772-0693
Mailing address:
  • Phone: 727-772-5982
  • Fax: 727-772-0693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0055862
License Number StateFL

VIII. Authorized Official

Name: DR. CARLOS A HIDALGO
Title or Position: OWNER
Credential: M.D.
Phone: 727-772-5982