Healthcare Provider Details

I. General information

NPI: 1063352722
Provider Name (Legal Business Name): LISA JIMENEZ PMHNP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 ABBEY LN UNIT 409
ASTORIA OR
97103-2239
US

IV. Provider business mailing address

3930 ABBEY LN UNIT 409
ASTORIA OR
97103-2239
US

V. Phone/Fax

Practice location:
  • Phone: 661-348-6888
  • Fax: 800-878-9869
Mailing address:
  • Phone: 661-348-6888
  • Fax: 800-878-9869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LISA ANN JIMENEZ
Title or Position: PROVIDER
Credential: PMHNP
Phone: 661-348-6888