MEDICARE: ELIZABETH PINO JIMENEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-25-86482	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104530617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH PINO JIMENEZ

Provider Business Mailing Address
First Line	:	17985 NW 74TH CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-8443
Country	:	US
Telephone Number	:	786-554-3560
Fax Number	:

Provider Business Practice Location Address
First Line	:	17985 NW 74TH CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-8443
Country	:	US
Telephone Number	:	786-554-3560
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2023
Last Update Date	:	03/09/2026

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