Provider Demographics
NPI:1154986537
Name:JIMENEZ, IMANDRA (RBT)
Entity type:Individual
Prefix:
First Name:IMANDRA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5851 SW 148TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2452
Mailing Address - Country:US
Mailing Address - Phone:305-510-2275
Mailing Address - Fax:
Practice Address - Street 1:9290 HAMMOCKS BLVD STE 401
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1347
Practice Address - Country:US
Practice Address - Phone:786-558-5694
Practice Address - Fax:786-913-7034
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-83714106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician