Provider Demographics
NPI:1558699330
Name:HILDA JUSTINIANO, INC.
Entity Type:Organization
Organization Name:HILDA JUSTINIANO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:HILDAMARI
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTINIANO GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-806-2222
Mailing Address - Street 1:PO BOX 3047
Mailing Address - Street 2:MARINA STATION
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3047
Mailing Address - Country:US
Mailing Address - Phone:787-806-2222
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA #2 KM. 173.4
Practice Address - Street 2:TORRE MEDICA SAN VICENTE DE PAUL #301
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-806-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-07
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15662261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1083818009OtherNPI