Provider Demographics
NPI:1952835308
Name:JIMENEZ JORGE, MARISLEYDI
Entity Type:Individual
Prefix:
First Name:MARISLEYDI
Middle Name:
Last Name:JIMENEZ JORGE
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 1:6128 HAYES ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6026
Mailing Address - Country:US
Mailing Address - Phone:786-343-8437
Mailing Address - Fax:
Practice Address - Street 1:6128 HAYES ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-6026
Practice Address - Country:US
Practice Address - Phone:786-343-8437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician