Provider Demographics
NPI:1720731284
Name:JUSTO, LITO B
Entity Type:Individual
Prefix:
First Name:LITO
Middle Name:B
Last Name:JUSTO
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 1:3619 SPRUCE PARK CIR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77345-3054
Mailing Address - Country:US
Mailing Address - Phone:304-553-9729
Mailing Address - Fax:
Practice Address - Street 1:108 S WILLIAM BARNETT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-4542
Practice Address - Country:US
Practice Address - Phone:281-659-2355
Practice Address - Fax:281-592-1570
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1068031363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily