Provider Demographics
NPI:1205032471
Name:JUSTINIANO, LIZBETTE (M D)
Entity Type:Individual
Prefix:DR
First Name:LIZBETTE
Middle Name:
Last Name:JUSTINIANO
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3367 CALLE GALAXIA
Mailing Address - Street 2:STALIGHT
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1473
Mailing Address - Country:US
Mailing Address - Phone:787-316-8846
Mailing Address - Fax:787-984-2986
Practice Address - Street 1:2213 PONCE BYP
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1318
Practice Address - Country:US
Practice Address - Phone:787-840-8686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16257208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice