1013432756 NPI number — DR. C. JUSTICE NACCARATO DACM, MSTOM

Table of content: DR. C. JUSTICE NACCARATO DACM, MSTOM (NPI 1013432756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013432756 NPI number — DR. C. JUSTICE NACCARATO DACM, MSTOM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NACCARATO
Provider First Name:
C. JUSTICE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DACM, MSTOM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NACCARATO
Provider Other First Name:
CASEY
Provider Other Middle Name:
JUSTICE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DACM, MSTOM
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1013432756
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4225 OCEANSIDE BLVD STE H
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCEANSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92056-3473
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-688-8054
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4225 OCEANSIDE BLVD STE H
Provider Second Line Business Practice Location Address:
#344
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92056-3473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-688-8054
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/03/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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