Provider Demographics
NPI:1457152944
Name:MATOS JIMENEZ, XIOMARA (RBT)
Entity type:Individual
Prefix:
First Name:XIOMARA
Middle Name:
Last Name:MATOS JIMENEZ
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-6331
Mailing Address - Country:US
Mailing Address - Phone:956-730-7277
Mailing Address - Fax:
Practice Address - Street 1:3970 TAMPA RD STE E
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-3201
Practice Address - Country:US
Practice Address - Phone:813-305-7037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-24-338743106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician