Provider Demographics
NPI:1679965768
Name:MAKENCIE-JAIMES, ALIX
Entity type:Individual
Prefix:
First Name:ALIX
Middle Name:
Last Name:MAKENCIE-JAIMES
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 1:405 DEER POINTE CIR
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-4714
Mailing Address - Country:US
Mailing Address - Phone:786-234-5651
Mailing Address - Fax:
Practice Address - Street 1:405 DEER POINTE CIR
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-4714
Practice Address - Country:US
Practice Address - Phone:786-234-5651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-26
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency