Provider Demographics
NPI:1215024518
Name:JOHNSON, YVONNE DIANE (MBA, RD)
Entity Type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:DIANE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MBA, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12646 SPRINGBROOK DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-5031
Mailing Address - Country:US
Mailing Address - Phone:858-513-3648
Mailing Address - Fax:
Practice Address - Street 1:3350 LA VILLAGE DR
Practice Address - Street 2:NFS 120
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-0001
Practice Address - Country:US
Practice Address - Phone:858-552-8585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered