1598701724 NPI number — DR. MARCOS ANTONIO JUSTINANO MD

Table of content: DR. MARCOS ANTONIO JUSTINANO MD (NPI 1598701724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598701724 NPI number — DR. MARCOS ANTONIO JUSTINANO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JUSTINANO
Provider First Name:
MARCOS
Provider Middle Name:
ANTONIO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598701724
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1575 AVE MUNOZ RIVERA
Provider Second Line Business Mailing Address:
PMB 250
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00717-0211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-644-6323
Provider Business Mailing Address Fax Number:
787-644-6323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PLAZA GABRIELA BO. CANAS
Provider Second Line Business Practice Location Address:
CARR. 132 KM 22.1
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-812-3930
Provider Business Practice Location Address Fax Number:
787-812-3931
Provider Enumeration Date:
06/22/2006

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: 208000000X , with the licence number:  12205 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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