MEDICARE: DR. JENNIFER MICHELE JOHNSON-PATEL M.D.

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	208000000X	Pediatrics Physician	A86243	CA

General Provider Information

NPI Number	:	1811973555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER MICHELE JOHNSON-PATEL M.D.

Provider Business Mailing Address
First Line	:	3514 30TH ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-4120
Country	:	US
Telephone Number	:	619-515-2424
Fax Number	:

Provider Business Practice Location Address
First Line	:	3514 30TH ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-4120
Country	:	US
Telephone Number	:	619-515-2424
Fax Number	:

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	03/16/2012

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