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 1:222 CARMEN LN STE 106
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7700
Mailing Address - Country:US
Mailing Address - Phone:058-450-3330
Mailing Address - Fax:
Practice Address - Street 1:222 CARMEN LN STE 106
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-7700
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:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator