MEDICARE: EMMET JOHANSSON NASM-CES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1578421996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMET JOHANSSON NASM-CES

Provider Business Mailing Address
First Line	:	2108 N ST STE N
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-5712
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	964 46TH ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94608-3450
Country	:	US
Telephone Number	:	510-500-5439
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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Directions to “ EMMET JOHANSSON NASM-CES” Practice Location

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