Healthcare Provider Details

I. General information

NPI: 1154652824
Provider Name (Legal Business Name): JUSTIN YOVINO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 NE 26TH AVE
FORT LAUDERDALE FL
33304-3607
US

IV. Provider business mailing address

910 NE 26TH AVE
FORT LAUDERDALE FL
33304-3607
US

V. Phone/Fax

Practice location:
  • Phone: 954-565-2330
  • Fax: 954-565-8994
Mailing address:
  • Phone: 954-565-2330
  • Fax: 954-565-8994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME103236
License Number StateFL

VIII. Authorized Official

Name: DR. JUSTIN YOVINO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 954-565-2330