Most Relevant Information
Provider Data
| NPI Number: | 1003656455 |
| Provider Name: | IVELISSI JIMENEZ-CRUZ RBT-24-329505 |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: | RBT-24-329505 |
Most Important Dates
| Enumeration Date: | 05/31/2024 |
| Last Updated: | 05/31/2024 |
Provider Practice Location
3104 W WATERS AVE STE 204
TAMPA
FL
336142877
Practice Location Phone/Fax
| Phone: | 8132654439 |
| Fax: |
Provider Mailing Location
10839 SAKONNET RIVER DR APT 203
TAMPA
FL
336152899
Provider Mailing Phone/Fax
| Phone: | 8134157581 |
| Fax: |