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General NPI Number Information
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NPI Number | 1811265739
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Entity Type | Individual
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Provider Name | CARLO ST. JUSTE JR. M.A.O.M., L.AC.
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Gender | Male
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Dates
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Enumeration Date | 12/06/2011
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 730 N MARIPOSA ST SUITE 101
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City | BURBANK
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State | CA
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Zip | 91506-1629
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Country | US
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Telephone | 818-848-2225
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Fax | 818-848-2227
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Provider Business Mailing Address
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Address Line | 730 N MARIPOSA ST SUITE 101
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City | BURBANK
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State | CA
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Zip | 91506-1629
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Country | US
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Telephone | 818-848-2225
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Fax | 818-848-2227
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC 14551
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License Number State | CA
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