Basic Information
| Provider Information | |||||||||
| NPI: | 1194711176 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUSTICE | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT LA23517 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911853517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664576411 | ||||||||
| FaxNumber: | 7066501034 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 E CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934545906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057393100 | ||||||||
| FaxNumber: | 8057393060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 12/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A71616 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 00A716160 | 05 | CA | MEDICAID |