Healthcare Provider Details

I. General information

NPI: 1497942106
Provider Name (Legal Business Name): PENNY ROUMANIS JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 06/01/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11411 BROOKSHIRE AVE STE 101
DOWNEY CA
90241-5008
US

IV. Provider business mailing address

1762 WESTWOOD BLVD STE 230
LOS ANGELES CA
90024-5648
US

V. Phone/Fax

Practice location:
  • Phone: 562-869-9192
  • Fax:
Mailing address:
  • Phone: 310-943-8400
  • Fax: 310-923-9912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA121083
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: