Provider Demographics
NPI:1851706592
Name:JIMENEZ CASIAN, MANDY
Entity Type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:
Last Name:JIMENEZ CASIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 318
Mailing Address - Street 2:
Mailing Address - City:PAPAIKOU
Mailing Address - State:HI
Mailing Address - Zip Code:96781-0318
Mailing Address - Country:US
Mailing Address - Phone:808-640-7038
Mailing Address - Fax:
Practice Address - Street 1:234 WAIANUENUE AVE STE 215
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2418
Practice Address - Country:US
Practice Address - Phone:808-935-7949
Practice Address - Fax:808-935-9700
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst