Provider Demographics
NPI:1487434437
Name:KIDZ DEVELOPMENT LAB CORP
Entity type:Organization
Organization Name:KIDZ DEVELOPMENT LAB CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:LOURDES
Authorized Official - Last Name:MARTIN-HIDALGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-512-8689
Mailing Address - Street 1:6175 NW 167TH ST STE G30
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4363
Mailing Address - Country:US
Mailing Address - Phone:786-200-3094
Mailing Address - Fax:
Practice Address - Street 1:1301 SW 134TH WAY APT 106B
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1894
Practice Address - Country:US
Practice Address - Phone:786-200-3494
Practice Address - Fax:305-512-8608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty