Provider Demographics
NPI:1508268301
Name:JOHNSON, ELI ROBIN (DO)
Entity Type:Individual
Prefix:
First Name:ELI
Middle Name:ROBIN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 685
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324
Mailing Address - Country:US
Mailing Address - Phone:951-486-4460
Mailing Address - Fax:951-486-6510
Practice Address - Street 1:26520 CACTUS AVENUE
Practice Address - Street 2:SUITE A2006
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555
Practice Address - Country:US
Practice Address - Phone:951-486-4460
Practice Address - Fax:951-486-6510
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A150102084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology