Provider Demographics
NPI:1073205043
Name:ROUINTAN, JUSTIN PAYOM (DO)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:PAYOM
Last Name:ROUINTAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8732 N 66TH PL
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-2304
Mailing Address - Country:US
Mailing Address - Phone:602-502-0062
Mailing Address - Fax:
Practice Address - Street 1:8732 N 66TH PL
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-2304
Practice Address - Country:US
Practice Address - Phone:602-502-0062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR4141207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine