Provider Demographics
NPI:1437182151
Name:CHRISTINE MARIE JOHNSTON MD INC
Entity Type:Organization
Organization Name:CHRISTINE MARIE JOHNSTON MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-524-2000
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:CA
Mailing Address - Zip Code:93016-0327
Mailing Address - Country:US
Mailing Address - Phone:805-524-2000
Mailing Address - Fax:805-524-9601
Practice Address - Street 1:552 SESPE AVE STE C
Practice Address - Street 2:
Practice Address - City:FILLMORE
Practice Address - State:CA
Practice Address - Zip Code:93015-1954
Practice Address - Country:US
Practice Address - Phone:805-524-2000
Practice Address - Fax:805-524-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77456261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM08907FMedicaid
CARHM08907FMedicaid
CA05-8907Medicare ID - Type Unspecified