Provider Demographics
NPI:1982254306
Name:BARSATAN, JUSTIN ELEGINO
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:ELEGINO
Last Name:BARSATAN
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 1:95-224 AUHAELE LOOP
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-1205
Mailing Address - Country:US
Mailing Address - Phone:808-365-8332
Mailing Address - Fax:
Practice Address - Street 1:95-224 AUHAELE LOOP
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-1205
Practice Address - Country:US
Practice Address - Phone:808-365-8332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician