Provider Demographics
NPI:1851303671
Name:LIMJOCO, BETTINA TAYENGCO (MD)
Entity Type:Individual
Prefix:DR
First Name:BETTINA
Middle Name:TAYENGCO
Last Name:LIMJOCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:949-201-0824
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:949-201-0824
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51899225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH91119Medicare UPIN