Provider Demographics
NPI:1790930485
Name:JAIMES, HENRY MIGUEL (BCABA)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:MIGUEL
Last Name:JAIMES
Suffix:
Gender:M
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14786 SW 101ST TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1699
Mailing Address - Country:US
Mailing Address - Phone:305-385-1017
Mailing Address - Fax:
Practice Address - Street 1:14786 SW 101ST TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1699
Practice Address - Country:US
Practice Address - Phone:305-385-1017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-04-1418103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0-04-1418Medicaid