Provider Demographics
NPI:1740973809
Name:SIMAUCHI, JANIMAR
Entity type:Individual
Prefix:
First Name:JANIMAR
Middle Name:
Last Name:SIMAUCHI
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 1:9704 LOU ANN AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-5012
Mailing Address - Country:US
Mailing Address - Phone:863-430-7030
Mailing Address - Fax:
Practice Address - Street 1:9704 LOU ANN AVE
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-5012
Practice Address - Country:US
Practice Address - Phone:863-430-7030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-266278106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician