Healthcare Provider Details

I. General information

NPI: 1326962739
Provider Name (Legal Business Name): LYNELLE RAE JOHNSON DVM, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE GARROD DRIVE
DAVIS CA
95616-2713
US

IV. Provider business mailing address

3206 CUTTER PL
DAVIS CA
95616-2713
US

V. Phone/Fax

Practice location:
  • Phone: 530-752-1393
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number27118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: