Provider Demographics
NPI:1306384680
Name:JUSTIN YOVINO MD PA
Entity Type:Organization
Organization Name:JUSTIN YOVINO MD PA
Other - Org Name:IDEAL FACE AND BODY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YOVINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-887-9999
Mailing Address - Street 1:462 N LINDEN DR
Mailing Address - Street 2:SUITE 440
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210
Mailing Address - Country:US
Mailing Address - Phone:310-887-9999
Mailing Address - Fax:888-434-6088
Practice Address - Street 1:462 N LINDEN DR
Practice Address - Street 2:SUITE 440
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210
Practice Address - Country:US
Practice Address - Phone:310-887-9999
Practice Address - Fax:888-434-6088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA119057261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical