Healthcare Provider Details

I. General information

NPI: 1770808719
Provider Name (Legal Business Name): MARY MICHELE LIMBO CORPUZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY MICHELE LIMBO

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ B711 RRUMC
LOS ANGELES CA
90095-7419
US

IV. Provider business mailing address

757 WESTWOOD PLZ B711 RRUMC
LOS ANGELES CA
90095-7419
US

V. Phone/Fax

Practice location:
  • Phone: 310-267-9128
  • Fax:
Mailing address:
  • Phone: 310-267-9128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA119090
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: