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General NPI Number Information
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NPI Number | 1629134986
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Entity Type | Organization
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Legal Business Name | MEDICAL OFFICE OF CONCEPCION AND LIM
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1646 BROADWAY ST
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City | VALLEJO
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State | CA
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Zip | 94590-2405
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Country | US
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Telephone | 707-645-8576
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Fax |
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Provider Business Mailing Address
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Address Line | 1646 BROADWAY ST
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City | VALLEJO
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State | CA
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Zip | 94590-2405
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LINDA HAROLD
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Credential |
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Telephone | 707-645-8576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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