Healthcare Provider Details

I. General information

NPI: 1558671222
Provider Name (Legal Business Name): JOYCE REDOR LIM CNA/4/11
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 TARTAR LANE 22
COMPTON CA
90221
US

IV. Provider business mailing address

1680 TARTAR LANE 22
COMPTON CA
90221
US

V. Phone/Fax

Practice location:
  • Phone: 323-805-1113
  • Fax: 310-884-9375
Mailing address:
  • Phone: 323-805-1113
  • Fax: 310-884-9375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number10003331
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number00693142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: