Provider Demographics
NPI:1558074245
Name:JIMENEZ, GIOVANNY ANDRES
Entity Type:Individual
Prefix:
First Name:GIOVANNY
Middle Name:ANDRES
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8015 SW 107TH AVE APT 314
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-4824
Mailing Address - Country:US
Mailing Address - Phone:786-405-4422
Mailing Address - Fax:
Practice Address - Street 1:8015 SW 107TH AVE APT 314
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-4824
Practice Address - Country:US
Practice Address - Phone:786-405-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-249595106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician