Provider Demographics
NPI:1780578120
Name:DE LA CALLE JIMENEZ, ALICIA CLAIRE
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:CLAIRE
Last Name:DE LA CALLE JIMENEZ
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 1:658 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-4140
Mailing Address - Country:US
Mailing Address - Phone:786-518-4915
Mailing Address - Fax:786-518-4915
Practice Address - Street 1:658 E 20TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-4140
Practice Address - Country:US
Practice Address - Phone:786-518-4915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-43980106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician