Provider Demographics
NPI:1053429597
Name:LIMBO, LOURDES C (PA)
Entity type:Individual
Prefix:MS
First Name:LOURDES
Middle Name:C
Last Name:LIMBO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24911
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0911
Mailing Address - Country:US
Mailing Address - Phone:206-788-3683
Mailing Address - Fax:
Practice Address - Street 1:720 8TH AVE S
Practice Address - Street 2:SUITE 100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3032
Practice Address - Country:US
Practice Address - Phone:206-788-3730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10001598363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LI8116OtherREGENCE BLUESHIELD
WA8373557Medicaid
WA132435OtherL&I
S94866Medicare UPIN
WA8373557Medicaid