Healthcare Provider Details

I. General information

NPI: 1710979190
Provider Name (Legal Business Name): CAROL ANNE LIM GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 BUSH ST
SAN FRANCISCO CA
94109-5611
US

IV. Provider business mailing address

251 DANTLEY WAY
WALNUT CREEK CA
94598-1804
US

V. Phone/Fax

Practice location:
  • Phone: 415-292-8888
  • Fax: 415-292-8845
Mailing address:
  • Phone: 925-945-0497
  • Fax: 415-292-8845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number469377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: