Healthcare Provider Details

I. General information

NPI: 1104910306
Provider Name (Legal Business Name): DAVID SCOTT JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49305 GRAPEFRUIT BLVD STE 1
COACHELLA CA
92236-1490
US

IV. Provider business mailing address

31938 TEMECULA PKWY STE A337
TEMECULA CA
92592-6810
US

V. Phone/Fax

Practice location:
  • Phone: 760-398-0723
  • Fax:
Mailing address:
  • Phone:
  • Fax: 760-398-0723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number12949
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA88275
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: