Individual
JUSTIN D'AVANZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4647 ZION AVE STE 1116, SAN DIEGO, CA 92120-2507
(619) 528-5164
Mailing address
4647 ZION AVE STE 1116, SAN DIEGO, CA 92120-2507
(619) 528-5164
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
177986
CA
207P00000X
Emergency Medicine Physician
Primary
69521
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/22/2020
Last updated
04/01/2024
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