Provider Demographics
NPI:1386535193
Name:MINJAREZ, MIA SARA I
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:SARA
Last Name:MINJAREZ
Suffix:I
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MIA
Other - Middle Name:SARA
Other - Last Name:MINJAREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10405 VIENNA ST # I207
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3897
Mailing Address - Country:US
Mailing Address - Phone:619-733-3403
Mailing Address - Fax:
Practice Address - Street 1:4284 TRAIL BOSS DR STE 110
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-7521
Practice Address - Country:US
Practice Address - Phone:619-733-3403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical