Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 95012857 | CA |
N | 363LP2300X | Nurse Practitioner - Primary Care | 95012857 | CA |
NPI | 1053962597 |
---|---|
Provider Name | Mr. Laudimir A. Limqueco |
First Address | Union City, CA 94587-4828 |
Second Address | Union City, CA 94587-4828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2019 |
Last Update Date | 26/09/2019 |