Provider Demographics
NPI:1013697747
Name:TANO, JUSTIN GUERRERO
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:GUERRERO
Last Name:TANO
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 1:1684 NAKULA ST
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-2631
Mailing Address - Country:US
Mailing Address - Phone:808-220-2909
Mailing Address - Fax:
Practice Address - Street 1:1684 NAKULA ST
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-2631
Practice Address - Country:US
Practice Address - Phone:808-220-2909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist