Healthcare Provider Details

I. General information

NPI: 1619272168
Provider Name (Legal Business Name): MADELE LIMPAHAN P.A-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SAN PABLO AVE
ALBANY CA
94706-1103
US

IV. Provider business mailing address

500 SAN PABLO AVE
ALBANY CA
94706-1103
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-8130
  • Fax: 510-524-0861
Mailing address:
  • Phone: 510-204-8130
  • Fax: 510-524-0861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA22511
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: