Provider Demographics
NPI:1225545189
Name:ROJO, JUSTIN (MA, ATC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:ROJO
Suffix:
Gender:M
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 HERVEY LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-1849
Mailing Address - Country:US
Mailing Address - Phone:609-553-6619
Mailing Address - Fax:
Practice Address - Street 1:500 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-4345
Practice Address - Country:US
Practice Address - Phone:408-554-6941
Practice Address - Fax:408-551-1744
Is Sole Proprietor?:No
Enumeration Date:2018-01-01
Last Update Date:2018-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ20000211922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer