| Doctor Name: | MIA JIMENEZ |
| NPI Number: | 1225479587 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | ASW62106 |
| Business Practice Address: | 9101 Whittier Blvd Pico Rivera, CA - 906602405 |
| Business Phone Number: | 5628014626 |
| Business Fax Number: | |
| Mailing Address: | 1000 Corporate Center Dr Ste 650, MONTEREY PARK |
| State: | CA |
| Postal Code: | 917547639 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/15/2013 |
| NPI Last Update Date: | 09/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | ASW62106 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |