Doctor Name: | DR. AUSBERTO BIENVENIDO HIDALGO |
NPI Number: | 1144385592 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | ME0053208 |
Business Practice Address: | 302 Nw 179th Avenue Suite 103 Pembroke Pines, FL - 330292810 |
Business Phone Number: | 9544428380 |
Business Fax Number: | 9544428661 |
Mailing Address: | 302 Nw 179th Avenue, Suite 103 PEMBROKE PINES |
State: | FL |
Postal Code: | 330292810 |
Phone Number: | 9544428380 |
Fax Number: | 9544428661 |
NPI Enumeration Date: | 12/26/2006 |
NPI Last Update Date: | 01/20/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | ME0053208 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |