Marvin Olivo Justiniano, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

1063 Issued in PR

Practice address

Urb. Borinquen, Ee20, Jose Campeche St.
Cabo Rojo, PR 00623

Phone

(787) 233-2550

NPI assigned

Feb 7, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1675728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675728000000",
    "number": "1245936582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 774",
            "city": "MAYAGUEZ",
            "state": "PR",
            "postal_code": "006810774",
            "telephone_number": "787-233-2550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "URB. BORINQUEN, EE20, JOSE CAMPECHE ST.",
            "city": "CABO ROJO",
            "state": "PR",
            "postal_code": "00623",
            "telephone_number": "787-233-2550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLIVO JUSTINIANO",
        "first_name": "MARVIN",
        "name_prefix": "Dr.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-02-07",
        "last_updated": "2023-02-07",
        "certification_date": "2023-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PR",
            "license": "1063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• New Cras
• Nataly Andrea Nicolai, PHARMDC
• Rose Coraly Nieves Campis, O.T.
• Antonio Noriega Acosta, MD
• Irivette Ojeda, M.D.
• Brian Jomar Olivo Marti, MD
• Optica Perichi Cuidado Visual Eben-Ezer
• Carlos Antonio Ortiz - Soto, MD
• Danica Mariel Ortiz Ortiz, OD
• Gladys Del Carmen Ortiz Pagan, M.D.

• Medical Physician Assistant in Cabo Rojo, PR
• Providers in Cabo Rojo, PR by specialty
• Medical Physician Assistant in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.