Healthcare Provider Details

I. General information

NPI: 1194148882
Provider Name (Legal Business Name): VINCENT PHUOC LIM PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2014
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6326 VESPER AVE
VAN NUYS CA
91411-2339
US

IV. Provider business mailing address

401 E CARRILLO ST
SANTA BARBARA CA
93101-1460
US

V. Phone/Fax

Practice location:
  • Phone: 818-779-1500
  • Fax: 818-779-1551
Mailing address:
  • Phone: 805-563-3307
  • Fax: 805-563-0998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: