Provider Demographics
NPI:1700069911
Name:JOHNSON, NICHOLAS DAVID (SURGICAL TECH)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:DAVID
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:SURGICAL TECH
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Mailing Address - Street 1:519 E QUINCY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1605
Mailing Address - Country:US
Mailing Address - Phone:210-271-7819
Mailing Address - Fax:210-476-0937
Practice Address - Street 1:1303 MCCULLOUGH AVE
Practice Address - Street 2:SUITE 270
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5609
Practice Address - Country:US
Practice Address - Phone:210-271-3660
Practice Address - Fax:210-932-1951
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist