Provider Demographics
NPI:1154701142
Name:HIDALGO, IDANIA SIRLENY (MD)
Entity type:Individual
Prefix:
First Name:IDANIA
Middle Name:SIRLENY
Last Name:HIDALGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:820 S CARRIER PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-1517
Mailing Address - Country:US
Mailing Address - Phone:972-262-1425
Mailing Address - Fax:972-237-4973
Practice Address - Street 1:820 S CARRIER PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051
Practice Address - Country:US
Practice Address - Phone:972-262-1425
Practice Address - Fax:972-237-4973
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10053768207Q00000X
TXR3861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine