Provider Demographics
NPI:1467538710
Name:FONTANINI, JUSTIN GEORGE (DOM, AP)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:GEORGE
Last Name:FONTANINI
Suffix:
Gender:M
Credentials:DOM, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 58TH ST APT 1003
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-5513
Mailing Address - Country:US
Mailing Address - Phone:727-547-1956
Mailing Address - Fax:
Practice Address - Street 1:9070 58TH DR E
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-6110
Practice Address - Country:US
Practice Address - Phone:941-752-4838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2220171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist