Provider Demographics
NPI:1528736956
Name:JIMENEZ SANCHEZ, MARIA L
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:JIMENEZ SANCHEZ
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 1:18140 NW 68TH AVE APT 106C
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-7912
Mailing Address - Country:US
Mailing Address - Phone:786-655-2374
Mailing Address - Fax:
Practice Address - Street 1:18140 NW 68TH AVE APT 106C
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-7912
Practice Address - Country:US
Practice Address - Phone:786-655-2374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-167233106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112713100Medicaid