Provider Demographics
NPI:1215701636
Name:CAMEJO JIMENEZ, ROLANDO H SR
Entity type:Individual
Prefix:MR
First Name:ROLANDO
Middle Name:H
Last Name:CAMEJO JIMENEZ
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26870 SW 128TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-7846
Mailing Address - Country:US
Mailing Address - Phone:813-557-7176
Mailing Address - Fax:
Practice Address - Street 1:26870 SW 128TH AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-7846
Practice Address - Country:US
Practice Address - Phone:813-557-7176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-278893106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician