Provider Demographics
NPI:1689444077
Name:GAMBOA JIMENEZ, GEYDI LEYANIS I (RBT)
Entity Type:Individual
Prefix:
First Name:GEYDI
Middle Name:LEYANIS
Last Name:GAMBOA JIMENEZ
Suffix:I
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 1:13461 SW 272ND TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-2542
Mailing Address - Country:US
Mailing Address - Phone:786-869-0656
Mailing Address - Fax:
Practice Address - Street 1:13461 SW 272ND TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-2542
Practice Address - Country:US
Practice Address - Phone:786-869-0656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician