Healthcare Provider Details

I. General information

NPI: 1407376221
Provider Name (Legal Business Name): GRACE IVETH HIDALGO ARMENTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 07/21/2022
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 ALDINE MAIL RTE
HOUSTON TX
77039-3804
US

IV. Provider business mailing address

122 W JOHN CARPENTER FWY STE 420
IRVING TX
75039-2014
US

V. Phone/Fax

Practice location:
  • Phone: 281-598-3300
  • Fax: 281-598-3305
Mailing address:
  • Phone: 972-957-3000
  • Fax: 972-957-3005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberS6207
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: