Provider Demographics
NPI:1841299898
Name:CECILIO, ROSARIO LIM (MD)
Entity type:Individual
Prefix:DR
First Name:ROSARIO
Middle Name:LIM
Last Name:CECILIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ROSARIO RUBY
Other - Middle Name:LIM
Other - Last Name:CECILIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:15111 E. WHITTIER BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603
Mailing Address - Country:US
Mailing Address - Phone:562-945-6440
Mailing Address - Fax:562-945-9121
Practice Address - Street 1:15111 E. WHITTIER BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603
Practice Address - Country:US
Practice Address - Phone:562-945-6440
Practice Address - Fax:562-945-9121
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 46551207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA46551OtherBCBS
CA00A465510OtherBLUE SHIELD
CA00A46551Medicaid
CA010061986OtherMEDICARE RAIL ROAD
CAB003OtherCHAMPUS
CA00A46551Medicaid
CAB003OtherCHAMPUS