Provider Demographics
NPI:1508272501
Name:DEMBO, JUSTINE SARAH (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTINE
Middle Name:SARAH
Last Name:DEMBO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 ALMA REAL DR
Mailing Address - Street 2:SUITE 311
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3731
Mailing Address - Country:US
Mailing Address - Phone:424-203-3220
Mailing Address - Fax:866-282-5176
Practice Address - Street 1:881 ALMA REAL DR
Practice Address - Street 2:SUITE 311
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3731
Practice Address - Country:US
Practice Address - Phone:424-203-3220
Practice Address - Fax:866-282-5176
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1307072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry