Provider Demographics
NPI:1457880312
Name:HONDA, JUSTIN
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:HONDA
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 1:3641 HIGHBURY CT
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-1163
Mailing Address - Country:US
Mailing Address - Phone:805-791-7996
Mailing Address - Fax:
Practice Address - Street 1:1000 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:ATHERTON
Practice Address - State:CA
Practice Address - Zip Code:94027-4300
Practice Address - Country:US
Practice Address - Phone:805-791-7996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer