Provider Demographics
NPI:1013368372
Name:HIDALGO, ALEN (MD)
Entity type:Individual
Prefix:
First Name:ALEN
Middle Name:
Last Name:HIDALGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 SW 137TH AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6399
Mailing Address - Country:US
Mailing Address - Phone:305-459-3207
Mailing Address - Fax:305-459-3210
Practice Address - Street 1:2460 SW 137TH AVE STE 250
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6399
Practice Address - Country:US
Practice Address - Phone:305-459-3207
Practice Address - Fax:305-459-3210
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1428472084P0800X, 2084P0800X
NC2020-042842084P0800X
VA01012708272084P0800X
FLTRN23731390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL123189000Medicaid
FL123194500Medicaid