1174829253 NPI number — FRANK ROBERT LIMON CADTP

Table of content: FRANK ROBERT LIMON CADTP (NPI 1174829253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174829253 NPI number — FRANK ROBERT LIMON CADTP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIMON
Provider First Name:
FRANK
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CADTP
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:
1174829253
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 W 9TH ST UPLAND, CALIFORNIA 91786-5910
Provider Second Line Business Mailing Address:
333 E ARROW HWY UNIT 220
Provider Business Mailing Address City Name:
UPLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91786-7008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-476-2023
Provider Business Mailing Address Fax Number:
909-476-2043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 W 9TH ST UPLAND, CALIFORNIA 91786-5910
Provider Second Line Business Practice Location Address:
333 E ARROW HWY UNIT 220
Provider Business Practice Location Address City Name:
UPLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91786-7008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-476-2023
Provider Business Practice Location Address Fax Number:
909-476-2043
Provider Enumeration Date:
02/07/2011

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: 101YA0400X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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