Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 38257 | CA |
Y | 213EG0000X | General Practice | 38257 | CA |
NPI | 1003098757 |
---|---|
Provider Name | Dr. Dominga Lim Rarugal Bermoy |
First Address | Lawndale, CA 90260-1528 |
Second Address | Lawndale, CA 90260-1528 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2007 |
Last Update Date | 04/12/2007 |