Provider Demographics
NPI:1326565268
Name:POPE, JUSTIN (MSN)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:POPE
Suffix:
Gender:M
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23080 HAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5342
Mailing Address - Country:US
Mailing Address - Phone:909-835-0223
Mailing Address - Fax:
Practice Address - Street 1:1907 CYPRESS CREEK RD STE 108
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4151
Practice Address - Country:US
Practice Address - Phone:512-374-1876
Practice Address - Fax:512-371-8788
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA780786163WC0200X
CA119398367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine