Healthcare Provider Details

I. General information

NPI: 1568936920
Provider Name (Legal Business Name): GESSICA LOURINA LIMAHELU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26520 CACTUS AVE
MORENO VALLEY CA
92555-3927
US

IV. Provider business mailing address

26520 CACTUS AVE
MORENO VALLEY CA
92555-3927
US

V. Phone/Fax

Practice location:
  • Phone: 951-486-5634
  • Fax:
Mailing address:
  • Phone: 951-486-5634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA56477
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: