Provider Demographics
NPI:1881233609
Name:HIDALGO, ANTHONY (RT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:HIDALGO
Suffix:
Gender:M
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 N LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1849
Mailing Address - Country:US
Mailing Address - Phone:844-387-5836
Mailing Address - Fax:310-363-0349
Practice Address - Street 1:155 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1849
Practice Address - Country:US
Practice Address - Phone:844-387-5836
Practice Address - Fax:310-363-5836
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA309002278G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeneral Care