Provider Demographics
NPI:1720380298
Name:HIDALGO, ANGELA KAY
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KAY
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 1:910 MAIN ST
Mailing Address - Street 2:SUITE 362
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5720
Mailing Address - Country:US
Mailing Address - Phone:208-861-1680
Mailing Address - Fax:208-429-8233
Practice Address - Street 1:910 MAIN ST
Practice Address - Street 2:SUITE 362
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5720
Practice Address - Country:US
Practice Address - Phone:208-861-1680
Practice Address - Fax:208-429-8233
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist