Provider Demographics
NPI:1942825609
Name:HIDALGO, YALEYDIS (RBT)
Entity Type:Individual
Prefix:
First Name:YALEYDIS
Middle Name:
Last Name:HIDALGO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13301 SW 132ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6188
Mailing Address - Country:US
Mailing Address - Phone:786-713-5553
Mailing Address - Fax:786-713-5559
Practice Address - Street 1:13301 SW 132ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6188
Practice Address - Country:US
Practice Address - Phone:786-713-5553
Practice Address - Fax:786-713-5559
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-120384106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician