Provider Demographics
NPI:1104933761
Name:LIM, BERNADETTE ANNE (DO)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:ANNE
Last Name:LIM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 WILSON TER
Mailing Address - Street 2:SUITE 250
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4071
Mailing Address - Country:US
Mailing Address - Phone:818-246-7115
Mailing Address - Fax:818-246-8352
Practice Address - Street 1:1505 WILSON TER
Practice Address - Street 2:SUITE 250
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4071
Practice Address - Country:US
Practice Address - Phone:818-246-7115
Practice Address - Fax:818-246-8352
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9107207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine