Healthcare Provider Details

I. General information

NPI: 1912742479
Provider Name (Legal Business Name): JOY JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 EL CAMINO REAL STE A
CARLSBAD CA
92008-1255
US

IV. Provider business mailing address

926 LUPINE HILLS DR UNIT 18
VISTA CA
92081-5356
US

V. Phone/Fax

Practice location:
  • Phone: 760-720-0966
  • Fax:
Mailing address:
  • Phone: 626-374-8584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number21001
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: