Provider Demographics
NPI:1548854862
Name:DABU, JUSTIN S
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:S
Last Name:DABU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90810-1519
Mailing Address - Country:US
Mailing Address - Phone:310-830-7803
Mailing Address - Fax:310-830-6606
Practice Address - Street 1:2515 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90810-1519
Practice Address - Country:US
Practice Address - Phone:310-830-7803
Practice Address - Fax:310-830-6606
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty