Healthcare Provider Details

I. General information

NPI: 1801740568
Provider Name (Legal Business Name): PETER LIM PPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2026
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8073 BROADWAY
LEMON GROVE CA
91945-2533
US

IV. Provider business mailing address

2 N EUCLID AVE STE A
NATIONAL CITY CA
91950-1967
US

V. Phone/Fax

Practice location:
  • Phone: 619-363-9642
  • Fax:
Mailing address:
  • Phone: 619-363-9642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number250252868
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: