Provider Demographics
NPI:1366742298
Name:MANUEL A. HIDALGO, D.C., P.A.
Entity type:Organization
Organization Name:MANUEL A. HIDALGO, D.C., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HIDALGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-279-2767
Mailing Address - Street 1:9055 SW 87TH AVE
Mailing Address - Street 2:SUITE 311
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2306
Mailing Address - Country:US
Mailing Address - Phone:305-279-2767
Mailing Address - Fax:305-270-1135
Practice Address - Street 1:9055 SW 87TH AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2309
Practice Address - Country:US
Practice Address - Phone:305-279-2767
Practice Address - Fax:305-270-1135
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MANUEL A. HIDALGO, D.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-26
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6410305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22782Medicare PIN