1902875982 NPI number — DR. MARILYN LIMFUECO DUBAN M.D.

Table of content: DR. BRUCE A KIRALY O.D. (NPI 1104906387)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902875982 NPI number — DR. MARILYN LIMFUECO DUBAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUBAN
Provider First Name:
MARILYN
Provider Middle Name:
LIMFUECO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1902875982
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2757
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92859-0757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-973-2650
Provider Business Mailing Address Fax Number:
714-973-2655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15910 VENTURA BLVD
Provider Second Line Business Practice Location Address:
SUITE 1502
Provider Business Practice Location Address City Name:
ENCINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91436-2802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-728-9877
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2006

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: 207L00000X , with the licence number:  A76592 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00A765920 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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