Provider Demographics
NPI:1407557069
Name:HIDALGO, CLARISSA LISETTE (RYT)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:LISETTE
Last Name:HIDALGO
Suffix:
Gender:F
Credentials:RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 N DRAKE AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-3630
Mailing Address - Country:US
Mailing Address - Phone:209-291-8829
Mailing Address - Fax:
Practice Address - Street 1:2602 N DRAKE AVE
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-3630
Practice Address - Country:US
Practice Address - Phone:209-291-8829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-10
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula