Provider Demographics
NPI:1871127472
Name:BAEZ SANCHEZ, XIMENA ESTEFANIA
Entity type:Individual
Prefix:
First Name:XIMENA
Middle Name:ESTEFANIA
Last Name:BAEZ 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 1:3737 PEACOCK AVE APT 220
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2864
Mailing Address - Country:US
Mailing Address - Phone:413-275-4791
Mailing Address - Fax:
Practice Address - Street 1:3737 PEACOCK AVE APT 220
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33146-2864
Practice Address - Country:US
Practice Address - Phone:413-275-4791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL1-20-42203103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician