MEDICARE: DR. LINDA JOHNSTON MD

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	207Q00000X	Family Medicine Physician	G43957	CA

General Provider Information

NPI Number	:	1790350361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA JOHNSTON MD

Provider Business Mailing Address
First Line	:	PO BOX 1238
Second Line	:
City	:	PROSPER
State	:	TX
Zip	:	75078-1238
Country	:	US
Telephone Number	:	805-480-1240
Fax Number	:

Provider Business Practice Location Address
First Line	:	18370 BURBANK BLVD STE 414
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91356-2843
Country	:	US
Telephone Number	:	818-776-8040
Fax Number	:

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

Provider Enumeration Date	:	05/25/2021
Last Update Date	:	05/25/2021

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