MEDICARE: ROXANA SOBRINO JIMENEZ

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-24-373380	FL

General Provider Information

NPI Number	:	1518791722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROXANA SOBRINO JIMENEZ

Provider Business Mailing Address
First Line	:	8358 MARTINGALE DR APT 206
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-8134
Country	:	US
Telephone Number	:	754-268-0208
Fax Number	:

Provider Business Practice Location Address
First Line	:	8358 MARTINGALE DR APT 206
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-8134
Country	:	US
Telephone Number	:	754-268-0208
Fax Number	:

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

Provider Enumeration Date	:	08/29/2024
Last Update Date	:	08/29/2024

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