Provider Demographics
NPI:1992348205
Name:JUSTO, MARIA ANGELICA (AGACNP)
Entity type:Individual
Prefix:
First Name:MARIA ANGELICA
Middle Name:
Last Name:JUSTO
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1876 CHAMPAGNE CT UNIT 6
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-8346
Mailing Address - Country:US
Mailing Address - Phone:240-643-1446
Mailing Address - Fax:
Practice Address - Street 1:754 MEDICAL CENTER CT STE 206
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6656
Practice Address - Country:US
Practice Address - Phone:619-482-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013085363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care