Healthcare Provider Details

I. General information

NPI: 1417466889
Provider Name (Legal Business Name): JAVIER PEREZ JIMENEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22977 SW 128TH AVE
MIAMI FL
33170-2759
US

IV. Provider business mailing address

22977 SW 128TH AVE
MIAMI FL
33170-2759
US

V. Phone/Fax

Practice location:
  • Phone: 786-212-6744
  • Fax:
Mailing address:
  • Phone: 786-212-6744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA-1-26-90100
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: