=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811692742
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIMA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2023
-----------------------------------------------------
Last Update Date | 03/31/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 N MESQUITE ST
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78202-2727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-223-4933
-----------------------------------------------------
Fax | 210-600-4068
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 N MESQUITE ST
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78202-2727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-633-6699
-----------------------------------------------------
Fax | 210-600-4068
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | YVETTE BUENO
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 210-633-6699
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------