Provider Demographics
NPI:1801409248
Name:LIMON, JAVIER BRUNO
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:BRUNO
Last Name:LIMON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4233 N 77TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033-2401
Mailing Address - Country:US
Mailing Address - Phone:602-399-4486
Mailing Address - Fax:
Practice Address - Street 1:4233 N 77TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-2401
Practice Address - Country:US
Practice Address - Phone:602-399-4486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program