Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301084948 | MI |
N | 2080P0210X | Pediatric Nephrologist | 036117155 | IL |
N | 2080P0210X | Pediatric Nephrologist | 2011-00127 | NC |
Y | 2080P0210X | Pediatric Nephrologist | 25MA10679200 | NJ |
NPI | 1548207038 |
---|---|
Provider Name | Guillermo Hidalgo |
First Address | Neptune, NJ 07753-2605 |
Second Address | Neptune, NJ 07753-4488 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 24/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036117155 | MEDICAL LICENSE (01) | IL |
161WY | BCBSNC (01) | NC |
5916951 | (05) | NC |
H98045 | (02) |