Provider Demographics
NPI:1275258402
Name:JUSTIMA, JOSUE
Entity type:Individual
Prefix:
First Name:JOSUE
Middle Name:
Last Name:JUSTIMA
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 1:2009 OYSTERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-1922
Mailing Address - Country:US
Mailing Address - Phone:561-396-8051
Mailing Address - Fax:
Practice Address - Street 1:5448 W ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5215
Practice Address - Country:US
Practice Address - Phone:561-396-8051
Practice Address - Fax:561-429-5161
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL130022471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL84-2898993OtherMEDICARE