Provider Demographics
NPI:1235295254
Name:JOHNSON, DARIN ERIC (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DARIN
Middle Name:ERIC
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CALLE MERECIDA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6847
Mailing Address - Country:US
Mailing Address - Phone:949-282-7540
Mailing Address - Fax:
Practice Address - Street 1:23961 CALLE DE LA MAGDALENA AVE
Practice Address - Street 2:SUITE 504
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3665
Practice Address - Country:US
Practice Address - Phone:949-588-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17664363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ34459Medicare UPIN