Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Lilian Renata Bornio Carrillo

Individual provider Physician Assistant · NPI 1275127979

Lilian Renata Bornio Carrillo is a Physician Assistant in Lake Oswego, Oregon. Qualified in 2022, 4 years ago. Practices with Nisha Jackson Inc, a 44-clinician group and accepts Medicare assignment. Licensed in Oregon.

Years since qualifying
4
Licensed in
OR
In the registry since
2021
Specialties on file
2
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Practice location Address checks out

16463 Boones Ferry Rd Ste 300
Lake Oswego, OR 97035-4376
Phone: (503) 658-9351
Fax: (541) 708-5934
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA211394 (OR)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X (OR)

Record details

NPI number1275127979
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedFebruary 23, 2021
Last updated in NPPESFebruary 15, 2024
Certification dateFebruary 15, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Nisha Jackson Inc — 44 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Lake Oswego