Healthcare Provider Details

I. General information

NPI: 1083963094
Provider Name (Legal Business Name): SANDRA SHAN LIM DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 6TH AVE STE 100
SAN DIEGO CA
92101-4368
US

IV. Provider business mailing address

UCSD DEPARTMENT OF PSYCHIATRY 9500 GILMAN DRIVE, 9116A
LA JOLLA CA
92093-0001
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2430
  • Fax:
Mailing address:
  • Phone: 858-534-4040
  • Fax: 858-822-0231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A13075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: