Provider Demographics
NPI:1598021990
Name:HIDALGO, ANNKATHLYLN REYES (IDMT)
Entity type:Individual
Prefix:
First Name:ANNKATHLYLN
Middle Name:REYES
Last Name:HIDALGO
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 BRADLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:TRAVIS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:94535-1345
Mailing Address - Country:US
Mailing Address - Phone:303-993-9275
Mailing Address - Fax:
Practice Address - Street 1:117 BRADLEY BLVD
Practice Address - Street 2:
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535-1345
Practice Address - Country:US
Practice Address - Phone:303-993-9275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians