Healthcare Provider Details

I. General information

NPI: 1538903703
Provider Name (Legal Business Name): ANEL LLANES JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2024
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 SE 12TH TER
HOMESTEAD FL
33033-5093
US

IV. Provider business mailing address

712 SE 12TH TER
HOMESTEAD FL
33033-5093
US

V. Phone/Fax

Practice location:
  • Phone: 305-930-4749
  • Fax:
Mailing address:
  • Phone: 305-930-4749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-345420
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: