Provider Demographics
NPI:1346992864
Name:FIGUEROA, JUSTIN ADONIS
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:ADONIS
Last Name:FIGUEROA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7226 SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2003
Mailing Address - Country:US
Mailing Address - Phone:818-235-1414
Mailing Address - Fax:
Practice Address - Street 1:4300 LATHAM ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4333
Practice Address - Country:US
Practice Address - Phone:951-922-5792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician