Provider Demographics
NPI:1770237737
Name:LIM, TRIXIE ZAMORA (NP)
Entity Type:Individual
Prefix:
First Name:TRIXIE
Middle Name:ZAMORA
Last Name:LIM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1738 RANCH RD
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-1422
Mailing Address - Country:US
Mailing Address - Phone:310-999-8760
Mailing Address - Fax:
Practice Address - Street 1:1738 RANCH RD
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-1422
Practice Address - Country:US
Practice Address - Phone:310-999-8760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019922363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily