Provider Demographics
NPI:1912686858
Name:HIDALGO, MAURO
Entity Type:Individual
Prefix:
First Name:MAURO
Middle Name:
Last Name:HIDALGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 PARK GRANADA STE 202
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1666
Mailing Address - Country:US
Mailing Address - Phone:818-932-9644
Mailing Address - Fax:
Practice Address - Street 1:4500 PARK GRANADA STE 202
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1666
Practice Address - Country:US
Practice Address - Phone:805-390-0973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician