Provider Demographics
NPI:1831303528
Name:JOHNSTON, GESSICA (MD)
Entity Type:Individual
Prefix:
First Name:GESSICA
Middle Name:
Last Name:JOHNSTON
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 1:896 TERRA CALIFORNIA DR
Mailing Address - Street 2:#3
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-3086
Mailing Address - Country:US
Mailing Address - Phone:925-287-8087
Mailing Address - Fax:925-287-1797
Practice Address - Street 1:500 AIRPORT BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-1980
Practice Address - Country:US
Practice Address - Phone:415-652-3581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22811208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG22811OtherLICENSE
AZ19812OtherLICENSE
CAG22811OtherLICENSE