Provider Demographics
NPI:1174359905
Name:JIMENEZ VERA, VLADIMIR (RBT)
Entity type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:
Last Name:JIMENEZ VERA
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14371 LAKE CRESCENT PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-3034
Mailing Address - Country:US
Mailing Address - Phone:305-796-9582
Mailing Address - Fax:
Practice Address - Street 1:14371 LAKE CRESCENT PL
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-3034
Practice Address - Country:US
Practice Address - Phone:305-796-9582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-361684106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician