Healthcare Provider Details

I. General information

NPI: 1255242699
Provider Name (Legal Business Name): INNER LUZ PSYCHIATRY NURSING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 LONG BEACH BLVD STE 321
LONG BEACH CA
90807-4025
US

IV. Provider business mailing address

3605 LONG BEACH BLVD STE 321
LONG BEACH CA
90807-4025
US

V. Phone/Fax

Practice location:
  • Phone: 323-366-4994
  • Fax: 323-372-2669
Mailing address:
  • Phone: 323-366-4994
  • Fax: 323-372-2669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERTO JIMENEZ
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential: NP
Phone: 323-366-4994