Provider Demographics
NPI:1083696314
Name:LIM-JAVATE, ROSANA MENDOZA (MD)
Entity Type:Individual
Prefix:
First Name:ROSANA
Middle Name:MENDOZA
Last Name:LIM-JAVATE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 HOSPITAL DR.
Mailing Address - Street 2:FAMILY HEALTH ASSOCIATES, P.C.
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-7152
Mailing Address - Country:US
Mailing Address - Phone:417-588-3918
Mailing Address - Fax:
Practice Address - Street 1:341 HOSPITAL DR.
Practice Address - Street 2:FAMILY HEALTH ASSOCIATES, P.C.
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-7152
Practice Address - Country:US
Practice Address - Phone:417-588-3918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002016794207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209210400Medicaid
H76992Medicare UPIN
0000917212245Medicare ID - Type Unspecified