Healthcare Provider Details

I. General information

NPI: 1003770785
Provider Name (Legal Business Name): LEMI LILO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 CAMINO LARGO DR
CHINO HILLS CA
91709-1039
US

IV. Provider business mailing address

2112 CAMINO LARGO DR
CHINO HILLS CA
91709-1039
US

V. Phone/Fax

Practice location:
  • Phone: 312-838-8231
  • Fax:
Mailing address:
  • Phone: 312-838-8231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95376549
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: