Provider Demographics
NPI:1649565128
Name:HIDALGO, KIRA MICHELLE (MS)
Entity Type:Individual
Prefix:
First Name:KIRA
Middle Name:MICHELLE
Last Name:HIDALGO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 MOODY CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-6067
Mailing Address - Country:US
Mailing Address - Phone:805-777-3500
Mailing Address - Fax:805-777-3510
Practice Address - Street 1:72 MOODY CT
Practice Address - Street 2:SUITE 101
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-6067
Practice Address - Country:US
Practice Address - Phone:805-777-3500
Practice Address - Fax:805-777-3510
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health