MEDICARE: AYLEN JIMENEZ CLAVIJO RBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-19101932	FL
2	106E00000X	Assistant Behavior Analyst	0-23-14912	FL
3	103K00000X	Behavior Analyst	1-26-90523	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477198505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYLEN JIMENEZ CLAVIJO RBT

Provider Business Mailing Address
First Line	:	507 SPRING HILL LAKE LOOP
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33993-4533
Country	:	US
Telephone Number	:	305-490-9121
Fax Number	:

Provider Business Practice Location Address
First Line	:	507 SPRING HILL LAKE LOOP
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33993-4533
Country	:	US
Telephone Number	:	305-490-9121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2019
Last Update Date	:	06/07/2026

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