MEDICARE: LEMI LILO RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95038601	CA
2	163WP0808X	Psychiatric/Mental Health Registered Nurse	95376549	CA

General Provider Information

NPI Number	:	1003770785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEMI LILO RN

Provider Business Mailing Address
First Line	:	2112 CAMINO LARGO DR
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-1039
Country	:	US
Telephone Number	:	312-838-8231
Fax Number	:

Provider Business Practice Location Address
First Line	:	2112 CAMINO LARGO DR
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-1039
Country	:	US
Telephone Number	:	312-838-8231
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	02/16/2026

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