Provider Demographics
NPI:1194851261
Name:CUBACUB, RODOLFO LIM (MD)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:LIM
Last Name:CUBACUB
Suffix:
Gender:M
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:MISBURGERSTR. 76
Mailing Address - Street 2:
Mailing Address - City:HANNOVER
Mailing Address - State:NIEDERSACHSEN
Mailing Address - Zip Code:30625
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CMR 457
Practice Address - Street 2:BOX 639
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09033
Practice Address - Country:US
Practice Address - Phone:354-6684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider