Provider Demographics
NPI:1992427751
Name:LIMPENGCO, KATHLEEN (BSN, RN, MSN - FNP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:LIMPENGCO
Suffix:
Gender:F
Credentials:BSN, RN, MSN - FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 SIERRA BONITA DR
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-2505
Mailing Address - Country:US
Mailing Address - Phone:951-315-7357
Mailing Address - Fax:
Practice Address - Street 1:3946 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3303
Practice Address - Country:US
Practice Address - Phone:213-382-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020364363LF0000X
CA95177598163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily