Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 95000203 | CA |
NPI | 1093130395 |
---|---|
Provider Name | Imelda Lim |
First Address | National City, CA 91950-7410 |
Second Address | San Diego, CA 92114-6572 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2014 |
Last Update Date | 03/04/2017 |