1194851261 NPI number — DR. RODOLFO LIM CUBACUB M.D.

Table of content: DR. RODOLFO LIM CUBACUB M.D. (NPI 1194851261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194851261 NPI number — DR. RODOLFO LIM CUBACUB M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUBACUB
Provider First Name:
RODOLFO
Provider Middle Name:
LIM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194851261
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MISBURGERSTR. 76
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HANNOVER
Provider Business Mailing Address State Name:
NIEDERSACHSEN
Provider Business Mailing Address Postal Code:
30625
Provider Business Mailing Address Country Code:
DE
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CMR 457
Provider Second Line Business Practice Location Address:
BOX 639
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
3546684
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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