Provider Demographics
NPI:1891112215
Name:JUSTINIANO, JOEL
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
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:K 121 CALLE MEDREGAL
Mailing Address - Street 2:ALTURAS DE PUERTO REAL
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623
Mailing Address - Country:US
Mailing Address - Phone:787-237-5752
Mailing Address - Fax:
Practice Address - Street 1:K121 CALLE MEDREGAL
Practice Address - Street 2:ALTURQAS DE PUERTO REAL
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-5103
Practice Address - Country:US
Practice Address - Phone:787-882-7750
Practice Address - Fax:787-882-7760
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR370662470A2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2470A2800XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health InformationAssistant Record Technician