Healthcare Provider Details

I. General information

NPI: 1073164364
Provider Name (Legal Business Name): ALEJANDRA JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2019
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 MAITLAND SUMMIT BLVD
ORLANDO FL
32810-5915
US

IV. Provider business mailing address

8701 MAITLAND SUMMIT BLVD
ORLANDO FL
32810-5915
US

V. Phone/Fax

Practice location:
  • Phone: 407-574-4629
  • Fax: 407-995-4480
Mailing address:
  • Phone: 407-574-4629
  • Fax: 407-965-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: