Provider Demographics
NPI:1558671222
Name:LIM, JOYCE REDOR (CNA-00693142-6/4/11)
Entity Type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:REDOR
Last Name:LIM
Suffix:
Gender:F
Credentials:CNA-00693142-6/4/11
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 TARTAR LANE
Mailing Address - Street 2:22
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221
Mailing Address - Country:US
Mailing Address - Phone:323-805-1113
Mailing Address - Fax:310-884-9375
Practice Address - Street 1:1680 TARTAR LANE
Practice Address - Street 2:22
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221
Practice Address - Country:US
Practice Address - Phone:323-805-1113
Practice Address - Fax:310-884-9375
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10003331253Z00000X
CA00693142372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No253Z00000XAgenciesIn Home Supportive Care