Basic Information
| Provider Information | |||||||||
| NPI: | 1205032471 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUSTINIANO | ||||||||
| FirstName: | LIZBETTE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M. D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3367 CALLE GALAXIA | ||||||||
| Address2: | STALIGHT | ||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007171473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7873168846 | ||||||||
| FaxNumber: | 7879842986 | ||||||||
| Practice Location | |||||||||
| Address1: | 2213 PONCE BYP | ||||||||
| Address2: | |||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007171318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878408686 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2007 | ||||||||
| LastUpdateDate: | 12/06/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 16257 | PR | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.