Healthcare Provider Details

I. General information

NPI: 1124515960
Provider Name (Legal Business Name): PABLO ANTONIO JIMENEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19837 NW 65TH CT
HIALEAH FL
33015-8114
US

IV. Provider business mailing address

19837 NW 65TH CT
HIALEAH FL
33015-8114
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 786-493-9316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-19-9681
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: