Basic Information
| Provider Information | |||||||||
| NPI: | 1629165329 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUSTIZ | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12876 PACKWOOD RD | ||||||||
| Address2: | |||||||||
| City: | N PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334082246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613853133 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5051 SE 110TH ST | ||||||||
| Address2: | |||||||||
| City: | BELLEVIEW | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344203115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526741730 | ||||||||
| FaxNumber: | 3526748930 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2006 | ||||||||
| LastUpdateDate: | 02/25/2019 | ||||||||
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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 | 207Q00000X | A63347 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ME80578 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | A63347 | 01 | CA | BLUE CROSS | OTHER | 115 | 01 | CA | CMSP | OTHER | 00G601660 | 01 | CA | BLUE SHIELD OF CALIFORNIA | OTHER |