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General NPI Number Information
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NPI Number | 1881881043
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Entity Type | Organization
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Legal Business Name | LIME AVENUE HEALTH CARE
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 10/03/2007
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Provider Practice Location Address
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Address Line | 116 W LIME AVE
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City | MONROVIA
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State | CA
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Zip | 91016-2841
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Country | US
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Telephone | 626-599-8323
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 486
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City | MONROVIA
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State | CA
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Zip | 91017-0486
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Country | US
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Telephone | 626-599-8323
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHANIE RODE
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Credential | D.O.
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Telephone | 626-599-8323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 20A8673
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License Number State | CA
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