Healthcare Provider Details

I. General information

NPI: 1255954855
Provider Name (Legal Business Name): STEP BY STEP PPEC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 NW 177TH ST
HIALEAH FL
33015-3645
US

IV. Provider business mailing address

8300 NW 177TH ST
HIALEAH FL
33015-3645
US

V. Phone/Fax

Practice location:
  • Phone: 786-367-1304
  • Fax:
Mailing address:
  • Phone: 786-367-1304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LISELY JIMENEZ
Title or Position: PRESIDENT
Credential: RN MSN
Phone: 786-367-1304