Provider Demographics
NPI:1245842103
Name:JOHNSON, COSSETTE GEORGINA
Entity type:Individual
Prefix:
First Name:COSSETTE
Middle Name:GEORGINA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 SANDY ST
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-5839
Mailing Address - Country:US
Mailing Address - Phone:619-219-4709
Mailing Address - Fax:
Practice Address - Street 1:9228 ALLANO WAY
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-2202
Practice Address - Country:US
Practice Address - Phone:619-596-2081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAN8143487OtherDRIVER LICENSE