Provider Demographics
NPI:1407224165
Name:STARGAARD, JUSTIN
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:STARGAARD
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 1:6051 FRESNO ST.
Mailing Address - Street 2:MAXIM STAFFING
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1895
Mailing Address - Country:US
Mailing Address - Phone:559-224-0299
Mailing Address - Fax:
Practice Address - Street 1:6051 FRESNO ST.
Practice Address - Street 2:MAXIM STAFFING
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-1895
Practice Address - Country:US
Practice Address - Phone:559-224-0299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34493374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician