Healthcare Provider Details

I. General information

NPI: 1174440788
Provider Name (Legal Business Name): LISA STONE DE JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA JIMENEZ

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4437 W BLACK CANYON RD
RIVERTON UT
84096-3482
US

IV. Provider business mailing address

4437 W BLACK CANYON RD
RIVERTON UT
84096-3482
US

V. Phone/Fax

Practice location:
  • Phone: 385-282-8586
  • Fax:
Mailing address:
  • Phone: 385-282-8586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: