MEDICARE: WHITTIER PRIMARY CARE PHYSICIANS MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	A40764	CA
2	208D00000X	General Practice Physician	A48517	CA
3	208D00000X	General Practice Physician	A16292	CA
4	208D00000X	General Practice Physician	20A3703	CA
5	208D00000X	General Practice Physician	A46551	CA

General Provider Information

NPI Number	:	1639177520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITTIER PRIMARY CARE PHYSICIANS MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	15111 WHITTIER BLVD
Second Line	:	SUITE 102
City	:	WHITTIER
State	:	CA
Zip	:	90603-2136
Country	:	US
Telephone Number	:	562-945-6440
Fax Number	:	562-945-9121

Provider Business Practice Location Address
First Line	:	15111 WHITTIER BLVD
Second Line	:	SUITE 102
City	:	WHITTIER
State	:	CA
Zip	:	90603-2136
Country	:	US
Telephone Number	:	562-945-6440
Fax Number	:	562-945-9121

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	DR. ROSARIO LIM CECILIO
Credential	:	MD
Telephone Number	:	562-228-3073

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	12/03/2021

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