Healthcare Provider Details

I. General information

NPI: 1194851261
Provider Name (Legal Business Name): RODOLFO LIM CUBACUB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 457 BOX 639
APO AE
09033
US

IV. Provider business mailing address

MISBURGERSTR. 76
HANNOVER NIEDERSACHSEN
30625
DE

V. Phone/Fax

Practice location:
  • Phone: 3546684
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: