Provider Demographics
NPI:1124892732
Name:JIMENEZ ARCEO, LEIDY DALIA
Entity type:Individual
Prefix:
First Name:LEIDY
Middle Name:DALIA
Last Name:JIMENEZ ARCEO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 SW EMBERS TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-1440
Mailing Address - Country:US
Mailing Address - Phone:239-237-8256
Mailing Address - Fax:
Practice Address - Street 1:1431 SW EMBERS TER
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-1440
Practice Address - Country:US
Practice Address - Phone:239-237-8256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-309847106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician