Provider Demographics
NPI:1689309767
Name:LIM, SAMANTHA KATE
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KATE
Last Name:LIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 HUMPHREY PL
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6946
Mailing Address - Country:US
Mailing Address - Phone:619-504-9291
Mailing Address - Fax:
Practice Address - Street 1:2141 PALOMAR AIRPORT RD STE 350
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1451
Practice Address - Country:US
Practice Address - Phone:760-438-0078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician