Healthcare Provider Details

I. General information

NPI: 1912822602
Provider Name (Legal Business Name): ALFRED HIDALGO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 NW 27TH AVE
MIAMI FL
33147-4909
US

IV. Provider business mailing address

6195 NW 186TH ST APT 204
HIALEAH FL
33015-6086
US

V. Phone/Fax

Practice location:
  • Phone: 305-244-4133
  • Fax: 305-397-1042
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT25-409860
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: