Provider Demographics
NPI:1104022078
Name:JOSE LIMON PROFESSIONAL MEDICAL COORPORATION
Entity Type:Organization
Organization Name:JOSE LIMON PROFESSIONAL MEDICAL COORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:LIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-242-2226
Mailing Address - Street 1:22635 ALESSANDRO BLVD.
Mailing Address - Street 2:UNIT 400, SUITE A
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-2854
Mailing Address - Country:US
Mailing Address - Phone:951-242-2226
Mailing Address - Fax:951-242-8969
Practice Address - Street 1:22635 ALESSANDRO BLVD.
Practice Address - Street 2:UNIT 400, SUITE A
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-2854
Practice Address - Country:US
Practice Address - Phone:951-242-2226
Practice Address - Fax:951-242-8969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA045442207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC61329Medicare UPIN
CAZZZ05578ZMedicare PIN