Provider Demographics
NPI:1497523450
Name:JUSTINIANO, OSCAR HUGO
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:HUGO
Last Name:JUSTINIANO
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 1:12 ANDROS ST
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-6818
Mailing Address - Country:US
Mailing Address - Phone:239-771-9496
Mailing Address - Fax:
Practice Address - Street 1:12 ANDROS ST
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-6818
Practice Address - Country:US
Practice Address - Phone:239-771-9496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-3314058106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician