Provider Demographics
NPI:1407258866
Name:LIM, DOUGLAS STEVEN (ARNP)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:STEVEN
Last Name:LIM
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5008
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94948-5008
Mailing Address - Country:US
Mailing Address - Phone:415-448-1500
Mailing Address - Fax:415-798-3104
Practice Address - Street 1:5 BON AIR RD STE 117
Practice Address - Street 2:
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1138
Practice Address - Country:US
Practice Address - Phone:408-368-4494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000478363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health