Provider Demographics
NPI:1457360240
Name:JOHNSTON, LAURIE LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:LOUISE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:17188 LIBERTAD DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1331
Mailing Address - Country:US
Mailing Address - Phone:858-673-0356
Mailing Address - Fax:858-673-8402
Practice Address - Street 1:3914 MURPHY CANYON RD
Practice Address - Street 2:SUITE A150
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4491
Practice Address - Country:US
Practice Address - Phone:858-573-9902
Practice Address - Fax:858-573-9906
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG062814207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE90850Medicare UPIN