Provider Demographics
NPI:1730117516
Name:JOHNSON, STEVEN BLAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:BLAINE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:303 W LINCOLN AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-2936
Mailing Address - Country:US
Mailing Address - Phone:717-520-7303
Mailing Address - Fax:714-520-0883
Practice Address - Street 1:303 W LINCOLN AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-2936
Practice Address - Country:US
Practice Address - Phone:717-520-7303
Practice Address - Fax:714-520-0883
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG572892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry