Provider Demographics
NPI:1700600772
Name:VILLAMIZAR, JESSICA KAROLAIN
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:KAROLAIN
Last Name:VILLAMIZAR
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 1:10360 SW 216TH ST APT 201
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1701
Mailing Address - Country:US
Mailing Address - Phone:786-296-7806
Mailing Address - Fax:
Practice Address - Street 1:10360 SW 216TH ST APT 201
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1701
Practice Address - Country:US
Practice Address - Phone:786-296-7806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-14
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-350020106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician