Provider Demographics
NPI:1669656393
Name:HIDALGO-BARNES, MIGUEL KELLER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:KELLER
Last Name:HIDALGO-BARNES
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3095 RICHMOND PKWY
Mailing Address - Street 2:STE 201
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-5878
Mailing Address - Country:US
Mailing Address - Phone:510-596-8125
Mailing Address - Fax:
Practice Address - Street 1:3095 RICHMOND PKWY
Practice Address - Street 2:STE 201
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-5878
Practice Address - Country:US
Practice Address - Phone:510-596-8125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24974103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical