Provider Demographics
NPI:1750152237
Name:JIMENEZ LOPEZ, YOEL (RBT-24-321103)
Entity type:Individual
Prefix:
First Name:YOEL
Middle Name:
Last Name:JIMENEZ LOPEZ
Suffix:
Gender:M
Credentials:RBT-24-321103
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 NW 49TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-3557
Mailing Address - Country:US
Mailing Address - Phone:786-689-1010
Mailing Address - Fax:
Practice Address - Street 1:2912 NW 49TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-3557
Practice Address - Country:US
Practice Address - Phone:786-689-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-321103106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician