Provider Demographics
NPI:1073700050
Name:JOHNSON, SANDRA GLADYS
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:GLADYS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:GLADYS
Other - Last Name:EDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1380 HOWARD ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2638
Mailing Address - Country:US
Mailing Address - Phone:415-255-3442
Mailing Address - Fax:415-255-3567
Practice Address - Street 1:1380 HOWARD ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2638
Practice Address - Country:US
Practice Address - Phone:415-255-3442
Practice Address - Fax:415-255-3567
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health