Provider Demographics
NPI:1215235643
Name:FRIMTZIS, MIA ROMERO (PSYD)
Entity type:Individual
Prefix:DR
First Name:MIA
Middle Name:ROMERO
Last Name:FRIMTZIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MIA
Other - Middle Name:
Other - Last Name:FRIMTZIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:3113 AREZZO DR
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7873
Mailing Address - Country:US
Mailing Address - Phone:760-902-7785
Mailing Address - Fax:
Practice Address - Street 1:3113 AREZZO DR
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7873
Practice Address - Country:US
Practice Address - Phone:760-902-7785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB34293103TB0200X, 103TC1900X, 103TC2200X, 103TF0000X, 103TP2701X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy