Provider Demographics
NPI:1194827980
Name:JOHNSTON, JERRILYN (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRILYN
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22290 FOOTHILL BLVD #1
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541
Mailing Address - Country:US
Mailing Address - Phone:510-581-1446
Mailing Address - Fax:510-581-1805
Practice Address - Street 1:22290 FOOTHILL BLVD #1
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541
Practice Address - Country:US
Practice Address - Phone:510-581-1446
Practice Address - Fax:510-581-1805
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG067392208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics