Provider Demographics
NPI:1992400691
Name:VARGAS, JIMENA (RBT)
Entity type:Individual
Prefix:MRS
First Name:JIMENA
Middle Name:
Last Name:VARGAS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:JIMENA
Other - Middle Name:
Other - Last Name:GUZMAN ROSAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:7108 S KANNER HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7462
Mailing Address - Country:US
Mailing Address - Phone:855-832-6727
Mailing Address - Fax:
Practice Address - Street 1:300 SABAL PALM LN APT 101
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1737
Practice Address - Country:US
Practice Address - Phone:980-271-0127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician