Provider Demographics
NPI:1295957660
Name:JOHNSON, MARTIN ARTHUR (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:ARTHUR
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 1:224 AVENIDA BARCELONA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-5468
Mailing Address - Country:US
Mailing Address - Phone:949-212-9624
Mailing Address - Fax:
Practice Address - Street 1:224 AVENIDA BARCELONA
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-5468
Practice Address - Country:US
Practice Address - Phone:949-212-9624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC3556302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC35563OtherLICENSE IN CA.
CAC35563OtherLICENSE IN CA.