Provider Demographics
NPI:1376314666
Name:ACEVEDO JIMERANEZ, DANIELLIS
Entity Type:Individual
Prefix:
First Name:DANIELLIS
Middle Name:
Last Name:ACEVEDO JIMERANEZ
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 1:18786 NE 18TH AVE APT 126
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4226
Mailing Address - Country:US
Mailing Address - Phone:786-823-4044
Mailing Address - Fax:
Practice Address - Street 1:1566 NE 191ST ST APT 227
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4110
Practice Address - Country:US
Practice Address - Phone:786-823-4044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-316827106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician