Provider Demographics
NPI:1558653972
Name:JIMENEZ, LISA (REHABILITATION SPECI)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:REHABILITATION SPECI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-5243
Mailing Address - Country:US
Mailing Address - Phone:805-614-4940
Mailing Address - Fax:805-614-0179
Practice Address - Street 1:222 CARMEN LN STE 104
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-7776
Practice Address - Country:US
Practice Address - Phone:805-450-3330
Practice Address - Fax:805-803-8647
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health