Healthcare Provider Details

I. General information

NPI: 1255623245
Provider Name (Legal Business Name): RAMONA ELIZABETH JOHNSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14150 CULVER DR
IRVINE CA
92604-0315
US

IV. Provider business mailing address

14150 CULVER DR
IRVINE CA
92604-0315
US

V. Phone/Fax

Practice location:
  • Phone: 949-857-0290
  • Fax:
Mailing address:
  • Phone: 949-857-0290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberG47238
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: