Healthcare Provider Details

I. General information

NPI: 1144421801
Provider Name (Legal Business Name): JUSTIN YOVINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 N LINDEN DR SUITE 440
BEVERLY HILLS CA
90212-2247
US

IV. Provider business mailing address

462 N LINDEN DR SUITE 440
BEVERLY HILLS CA
90212-2247
US

V. Phone/Fax

Practice location:
  • Phone: 310-887-9999
  • Fax: 888-434-6088
Mailing address:
  • Phone: 310-887-9999
  • Fax: 888-434-6088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME103236
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA119057
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: