Active NPI
Maria Carrillo Jimenez
- Mental Health Counselor
- Chino, CA
National Provider Identifier
1053034801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 12370
- Practice address
- 12598 Central Ave Ste 122
Chino, CA 91710-3500 - Phone
- (909) 766-0096
- Fax
- (909) 542-3161
- NPI assigned
- Sep 26, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 12370 | CA | Primary |
Addresses
Primary practice location
12598 Central Ave Ste 122
Chino, CA 91710-3500
Mailing address
12598 Central Ave Ste 122
Chino, CA 91710-3500
Phone (909) 766-0096
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664150400000",
"number": "1053034801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12598 CENTRAL AVE STE 122",
"city": "CHINO",
"state": "CA",
"postal_code": "917103500",
"telephone_number": "909-766-0096",
"fax_number": "909-542-3161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12598 CENTRAL AVE STE 122",
"city": "CHINO",
"state": "CA",
"postal_code": "917103500",
"telephone_number": "909-766-0096",
"fax_number": "909-542-3161"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JIMENEZ",
"first_name": "MARIA",
"middle_name": "CARRILLO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-26",
"last_updated": "2022-09-26",
"certification_date": "2022-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "12370",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.