Basic Information
| Provider Information | |||||||||
| NPI: | 1912071481 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALEZ HIDALGO | ||||||||
| FirstName: | HAYDEE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11480 BROOSHIRE AVE SUITE 309 | ||||||||
| Address2: | |||||||||
| City: | DWONEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902415025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628691201 | ||||||||
| FaxNumber: | 5628691281 | ||||||||
| Practice Location | |||||||||
| Address1: | 11480 BROOKSHIRE AVE STE 309 | ||||||||
| Address2: | |||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902415025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628691201 | ||||||||
| FaxNumber: | 5628691281 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 07/11/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 6538 | PR | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | G155495 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.