Provider Demographics
NPI:1033930334
Name:JIMENEZ DELGADO, LAURA LIZ
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LIZ
Last Name:JIMENEZ DELGADO
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 1:3536 CHESHIRE SQ APT D
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-3952
Mailing Address - Country:US
Mailing Address - Phone:305-330-8162
Mailing Address - Fax:
Practice Address - Street 1:4509 BEE RIDGE RD UNIT E
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-2539
Practice Address - Country:US
Practice Address - Phone:941-914-5272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-24-382008106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician