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General NPI Number Information
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NPI Number | 1043939192
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Entity Type | Individual
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Provider Name | JENNIFER LEIGH MIRMIRA
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Gender | Female
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Dates
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Enumeration Date | 08/23/2022
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Last Update Date | 08/27/2024
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Provider Practice Location Address
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Address Line | PO BOX 371
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City | SOUTH SAN FRANCISCO
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State | CA
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Zip | 94083-0371
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Country | US
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Telephone | 415-712-2328
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 420276
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City | SAN DIEGO
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State | CA
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Zip | 92142-0276
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Country | US
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Telephone | 323-552-9070
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 144523
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License Number State | CA
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