Provider Demographics
NPI:1235665191
Name:LIM, DANIELLE (ATC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:BACON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:3417 S LOWELL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-3846
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13800 BIOLA AVE
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90639-0002
Practice Address - Country:US
Practice Address - Phone:562-944-0351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer