Healthcare Provider Details

I. General information

NPI: 1144666413
Provider Name (Legal Business Name): ZACHARY JAMES JOHNSON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2531 W WOODLAND DR
ANAHEIM CA
92801
US

IV. Provider business mailing address

2531 W WOODLAND DR
ANAHEIM CA
92801-2637
US

V. Phone/Fax

Practice location:
  • Phone: 714-226-9888
  • Fax: 714-226-9887
Mailing address:
  • Phone: 714-226-9888
  • Fax: 714-226-9887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number36619
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: