Healthcare Provider Details

I. General information

NPI: 1104530617
Provider Name (Legal Business Name): ELIZABETH PINO JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17985 NW 74TH CT
HIALEAH FL
33015-8443
US

IV. Provider business mailing address

17985 NW 74TH CT
HIALEAH FL
33015-8443
US

V. Phone/Fax

Practice location:
  • Phone: 786-554-3560
  • Fax:
Mailing address:
  • Phone: 786-554-3560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-86482
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: