Provider Demographics
NPI:1760241905
Name:PI JIMENEZ, SILVIA CONSUELO
Entity Type:Individual
Prefix:
First Name:SILVIA
Middle Name:CONSUELO
Last Name:PI JIMENEZ
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 1:418 NW 19TH PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-7556
Mailing Address - Country:US
Mailing Address - Phone:239-258-8837
Mailing Address - Fax:
Practice Address - Street 1:418 NW 19TH PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33993-7556
Practice Address - Country:US
Practice Address - Phone:239-258-8837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician