Healthcare Provider Details

I. General information

NPI: 1588593651
Provider Name (Legal Business Name): CRISTINA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 BRIDGE ST
ARROYO GRANDE CA
93420-3311
US

IV. Provider business mailing address

227 BRIDGE ST
ARROYO GRANDE CA
93420-3311
US

V. Phone/Fax

Practice location:
  • Phone: 805-474-3400
  • Fax:
Mailing address:
  • Phone: 805-474-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number230061347
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: