Healthcare Provider Details

I. General information

NPI: 1104021617
Provider Name (Legal Business Name): CARLOS J JUSTIZ R.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 NW 42ND AVE SUITE # 302
MIAMI FL
33126-5683
US

IV. Provider business mailing address

13444 SW 62ND ST APT F112
MIAMI FL
33183-5074
US

V. Phone/Fax

Practice location:
  • Phone: 786-239-0823
  • Fax:
Mailing address:
  • Phone: 305-387-3133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License NumberCRT 63490
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: