Provider Demographics
NPI:1881845485
Name:NEGUSSE, JOHNNY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:
Last Name:NEGUSSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8221 ROCHESTER AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-0721
Mailing Address - Country:US
Mailing Address - Phone:330-353-1659
Mailing Address - Fax:
Practice Address - Street 1:8221 ROCHESTER AVE STE 130
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0721
Practice Address - Country:US
Practice Address - Phone:330-353-1659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXFN2058623207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services