Provider Demographics
NPI:1013913722
Name:JOHNSON, RONALD BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:BRUCE
Last Name:JOHNSON
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 1:1701 E CESAR E CHAVEZ AVE
Mailing Address - Street 2:STE 225/200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2496
Mailing Address - Country:US
Mailing Address - Phone:323-225-4300
Mailing Address - Fax:323-225-1803
Practice Address - Street 1:1701 E CESAR E CHAVEZ AVE
Practice Address - Street 2:STE 225/200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2496
Practice Address - Country:US
Practice Address - Phone:323-225-4300
Practice Address - Fax:323-225-1803
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55608207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WG55608CMedicare ID - Type Unspecified
E68418Medicare UPIN