Healthcare Provider Details

I. General information

NPI: 1720723752
Provider Name (Legal Business Name): MAYRETHE LIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 CAMINO DEL RIO N STE 400
SAN DIEGO CA
92108-5724
US

IV. Provider business mailing address

3111 CAMINO DEL RIO N STE 400
SAN DIEGO CA
92108-5724
US

V. Phone/Fax

Practice location:
  • Phone: 888-922-2843
  • Fax: 855-568-2494
Mailing address:
  • Phone: 888-922-2843
  • Fax: 855-568-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: