Healthcare Provider Details

I. General information

NPI: 1265876171
Provider Name (Legal Business Name): BRETT ALAN JOHNSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6939 SUNRISE BLVD STE 106
CITRUS HEIGHTS CA
95610-3153
US

IV. Provider business mailing address

6939 SUNRISE BLVD STE 106
CITRUS HEIGHTS CA
95610-3153
US

V. Phone/Fax

Practice location:
  • Phone: 916-587-8000
  • Fax: 916-480-8400
Mailing address:
  • Phone: 916-587-8000
  • Fax: 916-480-8400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number105310737-1204
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A22978
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: