Provider Demographics
NPI:1477081115
Name:HIDALGO MONER, ISIS MARIA
Entity Type:Individual
Prefix:
First Name:ISIS
Middle Name:MARIA
Last Name:HIDALGO MONER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5711 SW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-5113
Mailing Address - Country:US
Mailing Address - Phone:786-806-8293
Mailing Address - Fax:786-334-5826
Practice Address - Street 1:2886 SW 35TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-3408
Practice Address - Country:US
Practice Address - Phone:786-212-1008
Practice Address - Fax:786-334-5826
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL1-21-57374103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician