Provider Demographics
NPI:1164284931
Name:MARICHAL JIMENEZ, MERLYS ADRIANA
Entity Type:Individual
Prefix:
First Name:MERLYS
Middle Name:ADRIANA
Last Name:MARICHAL JIMENEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11120 SW 196TH ST APT B404
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-8349
Mailing Address - Country:US
Mailing Address - Phone:786-351-1680
Mailing Address - Fax:
Practice Address - Street 1:11120 SW 196TH ST APT B404
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-8349
Practice Address - Country:US
Practice Address - Phone:786-351-1680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician