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NPI Code Detail

MEDICARE: NELSON JIMENEZ BAEZ

MEDICARE: NELSON JIMENEZ BAEZ
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
1106S00000XBehavior TechnicianFL

General Provider Information

NPI Number : 1962993220
Entity Type Code : Individual
Provider Name (Legal Business Name) : NELSON JIMENEZ BAEZ
Provider Business Mailing Address
First Line : 2009 WINWARD RD APT 207
Second Line :
City : DAVENPORT
State : FL
Zip : 33896-5747
Country : US
Telephone Number : 786-262-7817
Fax Number :
Provider Business Practice Location Address
First Line : 4727 W IRLO BRONSON MEMORIAL HWY
Second Line :
City : KISSIMMEE
State : FL
Zip : 34746-5326
Country : US
Telephone Number : 321-972-4039
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2018
Last Update Date : 09/25/2025

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Directions to “ NELSON JIMENEZ BAEZ ” Practice Location

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