Healthcare Provider Details

I. General information

NPI: 1265232581
Provider Name (Legal Business Name): DIDENIA MEJIA DE JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 NE 8TH TER
POMPANO BEACH FL
33064-6478
US

IV. Provider business mailing address

2550 NE 8TH TER
POMPANO BEACH FL
33064-6478
US

V. Phone/Fax

Practice location:
  • Phone: 561-907-9944
  • Fax:
Mailing address:
  • Phone: 561-907-9944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: