Healthcare Provider Details

I. General information

NPI: 1801445564
Provider Name (Legal Business Name): RAUL RODRIGO LIMBARING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 N TUSTIN ST
ORANGE CA
92867-7716
US

IV. Provider business mailing address

23592 WINDSONG APT 37G
ALISO VIEJO CA
92656-2346
US

V. Phone/Fax

Practice location:
  • Phone: 714-598-3923
  • Fax:
Mailing address:
  • Phone: 949-735-8682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberRDA36551
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: