Provider Demographics
NPI:1164179214
Name:JOHNSON, RYAN THOMAS (PA)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:THOMAS
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3905 WARING RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4405
Mailing Address - Country:US
Mailing Address - Phone:760-724-9000
Mailing Address - Fax:760-724-3686
Practice Address - Street 1:3905 WARING RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4405
Practice Address - Country:US
Practice Address - Phone:760-724-9000
Practice Address - Fax:760-724-3686
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant