Provider Demographics
NPI:1649204579
Name:JOHNSON'S ORTHOPEDIC OF SAN DIEGO
Entity Type:Organization
Organization Name:JOHNSON'S ORTHOPEDIC OF SAN DIEGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-278-0518
Mailing Address - Street 1:7898 OSTROW ST
Mailing Address - Street 2:STE F
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111
Mailing Address - Country:US
Mailing Address - Phone:858-278-0518
Mailing Address - Fax:858-278-0323
Practice Address - Street 1:7898 OSTROW ST
Practice Address - Street 2:STE F
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111
Practice Address - Country:US
Practice Address - Phone:858-278-0518
Practice Address - Fax:858-278-0323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACO2384174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXA0028341Medicaid
CAXA0028341Medicaid