Provider Demographics
NPI:1902287709
Name:DE LIMA, FABIANE SANTOS (MD)
Entity Type:Individual
Prefix:
First Name:FABIANE
Middle Name:SANTOS
Last Name:DE LIMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FABIANE
Other - Middle Name:
Other - Last Name:SANTOS DE LIMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4647 ZION AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-2507
Mailing Address - Country:US
Mailing Address - Phone:619-528-5000
Mailing Address - Fax:
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:M/C 2030
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-702-6222
Practice Address - Fax:773-834-7250
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1250691152084N0400X
390200000X
CAA1705522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program