Provider Demographics
NPI:1508465097
Name:JIMENEZ MUSTELIER, MARELEN (RBT)
Entity Type:Individual
Prefix:MRS
First Name:MARELEN
Middle Name:
Last Name:JIMENEZ MUSTELIER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14859 SW 104TH ST APT 204
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-2431
Mailing Address - Country:US
Mailing Address - Phone:786-333-3577
Mailing Address - Fax:
Practice Address - Street 1:14859 SW 104TH ST APT 204
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-2431
Practice Address - Country:US
Practice Address - Phone:786-333-3577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-134161106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician