Provider Demographics
NPI:1972669570
Name:JIMENEZ, ROBERTO RAFAEL SR (MS)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:RAFAEL
Last Name:JIMENEZ
Suffix:SR
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14813 SW 178TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-7707
Mailing Address - Country:US
Mailing Address - Phone:305-331-8439
Mailing Address - Fax:
Practice Address - Street 1:14813 SW 178TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33187-7707
Practice Address - Country:US
Practice Address - Phone:305-331-8439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1984106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist