Dr. Edmundo Samuel Justino, MD
Internal Medicine, Gastroenterology in Prescott, AZ. Individual provider (NPI-1).
NPI number1720156136
StatusActive
Last updated in NPPESSep 29, 2025
Details
- NPI
- 1720156136
- Entity type
- Individual (NPI-1)
- Name
- Dr. Edmundo Samuel Justino
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Dec 1, 2006
- Certification date
- Sep 29, 2025
- Last updated
- Sep 29, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207RG0100X | Internal Medicine, Gastroenterology | 60368 | AZ | Yes |
| 207RG0100X | Internal Medicine, Gastroenterology | 11931 | ND |
Practice location
802 Ainsworth Dr Ste APrescott, AZ 86301-1623
Phone 928-771-5548 · Fax 928-771-5549
Mailing address
Po Box 10880Prescott, AZ 86304-0880
Phone 602-406-4786 · Fax 916-636-4358
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