Healthcare Provider Details

I. General information

NPI: 1003767732
Provider Name (Legal Business Name): BRYANT ALEX LIM PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10565 CIVIC CENTER DR
RANCHO CUCAMONGA CA
91730-3853
US

IV. Provider business mailing address

10565 CIVIC CENTER DR
RANCHO CUCAMONGA CA
91730-3853
US

V. Phone/Fax

Practice location:
  • Phone: 909-755-5533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA68208
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: