Provider Demographics
NPI:1811518731
Name:HIDALGO, YENISLEYDIS
Entity type:Individual
Prefix:
First Name:YENISLEYDIS
Middle Name:
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 1:7301 SAYBROOK POINT DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-3206
Mailing Address - Country:US
Mailing Address - Phone:702-929-0821
Mailing Address - Fax:
Practice Address - Street 1:3530 E FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5069
Practice Address - Country:US
Practice Address - Phone:702-929-0821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-01
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst