MEDICARE: ISABEL SOPHIA HIDASI

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1447134242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISABEL SOPHIA HIDASI

Provider Business Mailing Address
First Line	:	2001 HOYT ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80215-1639
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1938 N PENNSILVANIA STREET
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203
Country	:	US
Telephone Number	:	516-423-2302
Fax Number	:

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

Provider Enumeration Date	:	08/04/2025
Last Update Date	:	08/04/2025

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