Provider Demographics
NPI:1578111290
Name:JOHNSON, CHARMIE (CHLS)
Entity Type:Individual
Prefix:MS
First Name:CHARMIE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CHLS
Other - Prefix:
Other - First Name:CHARMIE
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4410 ROSEBUD LN APT C
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-6267
Mailing Address - Country:US
Mailing Address - Phone:619-504-3850
Mailing Address - Fax:
Practice Address - Street 1:7309 UNIVERSITY AVE STE B
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-0525
Practice Address - Country:US
Practice Address - Phone:619-504-3850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist