Provider Demographics
NPI:1689912529
Name:LIM, MICHELLE TERESA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:TERESA
Last Name:LIM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:LIM
Other - Last Name:SERRAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:27054 LA PAZ RD
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3041
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27054 LA PAZ RD
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3041
Practice Address - Country:US
Practice Address - Phone:949-831-9977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14726363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical