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NPI Code Detail

MEDICARE: MAIDEL GIMENEZ

MEDICARE: MAIDEL GIMENEZ
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
1103K00000XBehavior Analyst1-25-84882FL

Other Identifiers

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

General Provider Information

NPI Number : 1912690827
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAIDEL GIMENEZ
Provider Business Mailing Address
First Line : 7108 S KANNER HWY
Second Line :
City : STUART
State : FL
Zip : 34997-7462
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6421 N FLORIDA AVE STE D-1458
Second Line :
City : TAMPA
State : FL
Zip : 33604-6007
Country : US
Telephone Number : 855-832-6727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2023
Last Update Date : 05/05/2026

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Directions to “ MAIDEL GIMENEZ ” Practice Location

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