Provider Demographics
NPI:1285981472
Name:JIMENEZ, MAYA (PHD)
Entity type:Individual
Prefix:MRS
First Name:MAYA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2922 DE LA VINA ST
Mailing Address - Street 2:STE C
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3372
Mailing Address - Country:US
Mailing Address - Phone:213-503-0988
Mailing Address - Fax:866-246-1018
Practice Address - Street 1:2922 DE LA VINA ST
Practice Address - Street 2:STE C
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3372
Practice Address - Country:US
Practice Address - Phone:213-503-0988
Practice Address - Fax:866-246-1018
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABCBA-D (1-08-4394)103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABCBA-DOtherBOARD CERTIFIED BEHAVIORAL ANALYSIS