Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | T-1873 | NM |
Y | 222Z00000X | Podiatrist | T-1873 | NM |
NPI | 1013409051 |
---|---|
Provider Name | Dr. Ida M Lim |
First Address | Albuquerque, NM 87113-2613 |
Second Address | Albuquerque, NM 87108-5153 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2018 |
Last Update Date | 05/06/2018 |