Individual
TATIANA MIMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PPS
Contact information
Practice address
1111 W CENTURY BLVD, LODI, CA 95240-6605
(209) 331-7990
Mailing address
1848 COLOMBARD CIR, LODI, CA 95240-6172
(209) 565-7716
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
220122388
CA
Other
Enumeration date
07/24/2024
Last updated
07/24/2024
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