Provider Demographics
NPI:1679271613
Name:HIDALGO-GATO, YISNEY
Entity Type:Individual
Prefix:
First Name:YISNEY
Middle Name:
Last Name:HIDALGO-GATO
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 1:37 SE 24TH AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-1466
Mailing Address - Country:US
Mailing Address - Phone:239-785-4355
Mailing Address - Fax:
Practice Address - Street 1:37 SE 24TH AVE APT 5
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-1466
Practice Address - Country:US
Practice Address - Phone:239-785-4355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB864610106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty