Healthcare Provider Details

I. General information

NPI: 1285311589
Provider Name (Legal Business Name): MARIE JUSTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 SW 31ST AVE
FORT LAUDERDALE FL
33312-6906
US

IV. Provider business mailing address

14211 OAK RIDGE DR
DAVIE FL
33325-3074
US

V. Phone/Fax

Practice location:
  • Phone: 954-357-5200
  • Fax:
Mailing address:
  • Phone: 954-703-9745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberME86811
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: