Provider Demographics
NPI:1760922413
Name:BETTINA LIMJOCO MDPC
Entity Type:Organization
Organization Name:BETTINA LIMJOCO MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BETTINA
Authorized Official - Middle Name:TAYENGCO
Authorized Official - Last Name:LIMJOCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-840-8406
Mailing Address - Street 1:20072 SW BIRCH ST
Mailing Address - Street 2:SUITE 170
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-0794
Mailing Address - Country:US
Mailing Address - Phone:949-891-0945
Mailing Address - Fax:949-201-9824
Practice Address - Street 1:20072 SW BIRCH ST
Practice Address - Street 2:SUITE 170
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0794
Practice Address - Country:US
Practice Address - Phone:949-891-0945
Practice Address - Fax:949-201-9824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51899261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA89119Medicare UPIN