Healthcare Provider Details

I. General information

NPI: 1821330705
Provider Name (Legal Business Name): HILDA JUSTINIANO MD, P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PR-2 KM 150.2 BARRIO ALGARROBO
MAYAGUEZ PR
00682
US

IV. Provider business mailing address

PO BOX 3047
MAYAGUEZ PR
00681-3047
US

V. Phone/Fax

Practice location:
  • Phone: 787-806-2222
  • Fax: 800-317-9835
Mailing address:
  • Phone: 787-806-2222
  • Fax: 800-317-9835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number15662
License Number StatePR

VIII. Authorized Official

Name: DR. HILDAMARI JUSTINIANO GARCIA
Title or Position: PRESIDENT
Credential:
Phone: 787-644-7700