1013473511 NPI number — LYNN ADORA LIMA NP

Table of content: LYNN ADORA LIMA NP (NPI 1013473511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013473511 NPI number — LYNN ADORA LIMA NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIMA
Provider First Name:
LYNN
Provider Middle Name:
ADORA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
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:
1013473511
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 11216
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91226-7216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-572-6474
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MINUTE CLINIC 9795 BURBANK
Provider Second Line Business Practice Location Address:
511 N HOLLYWOOD WAY
Provider Business Practice Location Address City Name:
BURBANK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91505-3406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-841-0710
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2019

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: 363LF0000X , with the licence number:  95010959 , 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)