Provider Demographics
NPI:1104021617
Name:JUSTIZ, CARLOS J (RT)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:J
Last Name:JUSTIZ
Suffix:
Gender:M
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13444 SW 62ND ST APT F112
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5074
Mailing Address - Country:US
Mailing Address - Phone:305-387-3133
Mailing Address - Fax:
Practice Address - Street 1:351 NW 42ND AVE
Practice Address - Street 2:SUITE # 302
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5683
Practice Address - Country:US
Practice Address - Phone:786-239-0823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRT 634902471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography