Provider Demographics
NPI:1154641678
Name:JUSTIN MEDICAL SERVICES,INC
Entity type:Organization
Organization Name:JUSTIN MEDICAL SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:305-640-9601
Mailing Address - Street 1:3900 NW 79TH AVE STE 559
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6562
Mailing Address - Country:US
Mailing Address - Phone:305-640-9601
Mailing Address - Fax:305-640-9616
Practice Address - Street 1:3900 NW 79TH AVE STE 559
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6562
Practice Address - Country:US
Practice Address - Phone:305-640-9601
Practice Address - Fax:305-640-9616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-07
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM24928261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy