Healthcare Provider Details

I. General information

NPI: 1104639426
Provider Name (Legal Business Name): JOSE E JIJON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7841 SW 152ND AVE APT 3
MIAMI FL
33193-3203
US

IV. Provider business mailing address

7841 SW 152ND AVE APT 3
MIAMI FL
33193-3203
US

V. Phone/Fax

Practice location:
  • Phone: 786-306-7761
  • Fax:
Mailing address:
  • Phone: 786-306-7761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-407022
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: