Provider Demographics
NPI:1821330705
Name:HILDA JUSTINIANO MD, P.S.C.
Entity Type:Organization
Organization Name:HILDA JUSTINIANO MD, P.S.C.
Other - Org Name:HILDA JUSTINIANO GARCIA MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HILDAMARI
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTINIANO GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-644-7700
Mailing Address - Street 1:PO BOX 3047
Mailing Address - Street 2:
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:800-317-9835
Practice Address - Street 1:PR-2 KM 150.2
Practice Address - Street 2:BARRIO ALGARROBO
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682
Practice Address - Country:US
Practice Address - Phone:787-806-2222
Practice Address - Fax:800-317-9835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-19
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15662207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHR031AOtherPROVIDER TRANSACCTION AUTHORIZATION NUMBER - (PTAN)