Provider Demographics
NPI:1215318134
Name:LIM, ROBERTINO DOMINIC (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:ROBERTINO
Middle Name:DOMINIC
Last Name:LIM
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 ALAMEDA DE LAS PULGAS
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-4364
Mailing Address - Country:US
Mailing Address - Phone:650-573-3571
Mailing Address - Fax:
Practice Address - Street 1:375 89TH ST
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1802
Practice Address - Country:US
Practice Address - Phone:650-301-8650
Practice Address - Fax:650-301-8639
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1444812084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry