MEDICARE: JOSHUA HIDALGO CHW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker		NM

General Provider Information

NPI Number	:	1447058912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA HIDALGO CHW

Provider Business Mailing Address
First Line	:	117 CAMINO DE VIDA STE 300
Second Line	:
City	:	SANTA ROSA
State	:	NM
Zip	:	88435-2267
Country	:	US
Telephone Number	:	575-472-4311
Fax Number	:	877-651-0289

Provider Business Practice Location Address
First Line	:	1024 S. PACIFIC STREET
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-8843
Country	:	US
Telephone Number	:	505-426-2599
Fax Number	:	877-553-1272

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2025
Last Update Date	:	03/03/2025

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Directions to “ JOSHUA HIDALGO CHW” Practice Location

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