Provider Demographics
NPI:1780787762
Name:JOHNSTON, SUZANNE CHRISTINE (DO)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:CHRISTINE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15611 POMERADO RD STE 510
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2439
Mailing Address - Country:US
Mailing Address - Phone:858-312-5492
Mailing Address - Fax:
Practice Address - Street 1:15611 POMERADO RD STE 510
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2439
Practice Address - Country:US
Practice Address - Phone:858-312-5492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006423207R00000X
CA20A7079207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine