Individual provider Active NPI

Marina Jimenez

  • Professional Counselor
  • Universal City, TX
National Provider Identifier
1013782424
Registry record updated Nov 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
79035 Issued in TX
Practice address
433 Kitty Hawk Rd Ste 219
Universal City, TX 78148-3829
Phone
(210) 566-1280
Fax
(210) 579-8533
NPI assigned
Nov 16, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 79035 TX Primary

Addresses

Primary practice location

433 Kitty Hawk Rd Ste 219
Universal City, TX 78148-3829

Mailing address

433 Kitty Hawk Rd Ste 219
Universal City, TX 78148-3829
Phone (210) 566-1280

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
79035TXMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Alba Wellness Incorporated Professional CurrentSince Nov 19, 2023 Accepting new patients
Alba Wellness Case Management LLC PastSince Nov 19, 2023 Accepting new patients

Locations

433 Kitty Hawk Rd
Ste 219
Universal Cty, TX 78148
Phone (210) 566-1280

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1700092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700092800000",
    "number": "1013782424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "433 KITTY HAWK RD STE 219",
            "city": "UNIVERSAL CITY",
            "state": "TX",
            "postal_code": "781483829",
            "telephone_number": "210-566-1280",
            "fax_number": "210-579-8533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 KITTY HAWK RD STE 219",
            "city": "UNIVERSAL CITY",
            "state": "TX",
            "postal_code": "781483829",
            "telephone_number": "210-566-1280",
            "fax_number": "210-579-8533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIMENEZ",
        "first_name": "MARINA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-16",
        "last_updated": "2023-11-16",
        "certification_date": "2023-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "79035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Universal City, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.