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General NPI Number Information
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NPI Number | 1518262039
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Entity Type | Individual
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Provider Name | JUSTIN DEAN LATINO PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/13/2011
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Last Update Date | 11/16/2022
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Provider Practice Location Address
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Address Line | 4092 FOXWOOD DR SUITE 101
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-5225
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Country | US
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Telephone | 757-467-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 4092 FOXWOOD DRIVE SUITE 101
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City | VIRGINIA BEACH
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State | VIRGINIA
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Zip | 23462
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Country | UM
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Telephone | 757-467-4200
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Fax | 757-467-4173
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0110003499
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License Number State | VA
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