Individual provider Active NPI

Alonzo Rafael Hidalgo, OTR/L

  • Occupational Therapist
  • Pasadena, CA
National Provider Identifier
1144792193
Registry record updated Dec 31, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
19402 Issued in CA
Practice address
909 S Fair Oaks Ave
Pasadena, CA 91105-2625
Phone
(626) 389-9515
NPI assigned
Dec 31, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 31, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 19402 CA Primary

Addresses

Primary practice location

909 S Fair Oaks Ave
Pasadena, CA 91105-2625

Mailing address

909 S Fair Oaks Ave
Pasadena, CA 91105-2625
Phone (626) 389-9515

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190911002025 CA Practitioner - Occupational Therapist in Private Practice 8224367578 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
19402CAMDOccupational Therapist

Practice roles (2 of 3)

OrganizationSpecialtyStatusNew patients
Shriners Hospitals for Children CurrentSince Jun 22, 2019 Accepting new patients
Shriners Hospitals for Children CurrentSince Jun 22, 2019 Accepting new patients

Locations

909 S Fair Oaks Ave
Pasadena, CA 91105
Phone (213) 388-3151

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1546214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546214400000",
    "number": "1144792193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 S FAIR OAKS AVE",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911052625",
            "telephone_number": "626-389-9515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 S FAIR OAKS AVE",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911052625",
            "telephone_number": "626-389-9515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HIDALGO",
        "first_name": "ALONZO",
        "middle_name": "RAFAEL",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-12-31",
        "last_updated": "2018-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CA",
            "license": "19402",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasadena, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.