Provider Demographics
NPI:1558493585
Name:JOHNSON, ELIZABETH C (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:C
Last Name:JOHNSON
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 1:1351 24TH AVE
Mailing Address - Street 2:OCEAN PARK HEALTH CENTER
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-1616
Mailing Address - Country:US
Mailing Address - Phone:415-682-1931
Mailing Address - Fax:415-661-9733
Practice Address - Street 1:1351 24TH AVE
Practice Address - Street 2:OCEAN PARK HEALTH CENTER
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-1616
Practice Address - Country:US
Practice Address - Phone:415-682-1931
Practice Address - Fax:415-661-9733
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39514207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
004408OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER
004408OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER