Provider Demographics
NPI:1205407806
Name:XIMENEZ, VICTOR III (BA)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:XIMENEZ
Suffix:III
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:TREY
Other - Middle Name:
Other - Last Name:XIMENEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6107 BROADMEADOW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-2273
Mailing Address - Country:US
Mailing Address - Phone:210-478-6858
Mailing Address - Fax:
Practice Address - Street 1:3201 CHERRY RIDGE DR STE 205B
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-4832
Practice Address - Country:US
Practice Address - Phone:210-685-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-20-136016106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician