Provider Demographics
NPI:1013216258
Name:DEW, JUSTIN ALEXANDER
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:ALEXANDER
Last Name:DEW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:867 OXFORD CT
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3479
Mailing Address - Country:US
Mailing Address - Phone:916-860-9356
Mailing Address - Fax:
Practice Address - Street 1:867 OXFORD CT
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3479
Practice Address - Country:US
Practice Address - Phone:916-860-9356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45-1081076376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide