Healthcare Provider Details

I. General information

NPI: 1588911598
Provider Name (Legal Business Name): RICARDO R LIMON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 N MAIN ST SUITE 100
SANTA ANA CA
92701-4686
US

IV. Provider business mailing address

517 N MAIN ST SUITE 100
SANTA ANA CA
92701-4686
US

V. Phone/Fax

Practice location:
  • Phone: 714-647-0401
  • Fax: 714-647-0135
Mailing address:
  • Phone: 714-647-0401
  • Fax: 714-647-0135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA12050
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: