Provider Demographics
NPI:1720374531
Name:JOHNSON, ANDREA MICHELLE (DO)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MICHELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:MICHELLE
Other - Last Name:LOMBARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:26520 CACTUS AVENUE
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555
Mailing Address - Country:US
Mailing Address - Phone:951-486-4397
Mailing Address - Fax:951-486-5910
Practice Address - Street 1:26520 CACTUS AVENUE
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555
Practice Address - Country:US
Practice Address - Phone:951-486-4397
Practice Address - Fax:951-486-5910
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA20A12720207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program