Provider Demographics
NPI:1689435745
Name:HIDALGO, BETH A
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:HIDALGO
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 1:6100 N DURANGO
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-3939
Mailing Address - Country:US
Mailing Address - Phone:702-577-2606
Mailing Address - Fax:
Practice Address - Street 1:6200 N DURANGO DR STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-3939
Practice Address - Country:US
Practice Address - Phone:702-577-2606
Practice Address - Fax:702-710-6023
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-24-321378106S00000X
NVRBT4039106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty