Healthcare Provider Details

I. General information

NPI: 1639100498
Provider Name (Legal Business Name): RENE AUJERO LIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14427 CHASE ST STE. 100
PANORAMA CITY CA
91402-3020
US

IV. Provider business mailing address

11824 PORTER VALLEY DR
NORTHRIDGE CA
91326-1418
US

V. Phone/Fax

Practice location:
  • Phone: 818-830-7751
  • Fax: 818-891-7892
Mailing address:
  • Phone: 818-363-7198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA44687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: