Provider Demographics
NPI:1073313227
Name:JIMENEZ FRIOL, MELANIE DAYSI
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:DAYSI
Last Name:JIMENEZ FRIOL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 ABACO DR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2001
Mailing Address - Country:US
Mailing Address - Phone:561-468-1608
Mailing Address - Fax:
Practice Address - Street 1:129 ABACO DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-2001
Practice Address - Country:US
Practice Address - Phone:561-468-1608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLJ623483407000106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty