MEDICARE: MRS. MAYA JIMENEZ PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	BCBA-D (1-08-4394)	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BCBA-D	OTHER	CA	BOARD CERTIFIED BEHAVIORAL ANALYSIS

General Provider Information

NPI Number	:	1285981472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MAYA JIMENEZ PH.D.

Provider Business Mailing Address
First Line	:	2922 DE LA VINA ST
Second Line	:	STE C
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-3372
Country	:	US
Telephone Number	:	213-503-0988
Fax Number	:	866-246-1018

Provider Business Practice Location Address
First Line	:	2922 DE LA VINA ST
Second Line	:	STE C
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-3372
Country	:	US
Telephone Number	:	213-503-0988
Fax Number	:	866-246-1018

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2012
Last Update Date	:	08/07/2012

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