Healthcare Provider Details

I. General information

NPI: 1134038466
Provider Name (Legal Business Name): ABDIEL JIMENEZ RIVET
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3516 SHERYL HILL DR
HOLIDAY FL
34691-1437
US

IV. Provider business mailing address

3516 SHERYL HILL DR
HOLIDAY FL
34691-1437
US

V. Phone/Fax

Practice location:
  • Phone: 786-301-8438
  • Fax:
Mailing address:
  • Phone: 786-301-8438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberJ620963717000
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: