Healthcare Provider Details

I. General information

NPI: 1649443847
Provider Name (Legal Business Name): JOHNNY L. TRIPLETT M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3751 KATELLA AVE
LOS ALAMITOS CA
90720-3101
US

IV. Provider business mailing address

PO BOX 60790
PASADENA CA
91116-6790
US

V. Phone/Fax

Practice location:
  • Phone: 562-598-1311
  • Fax:
Mailing address:
  • Phone: 818-845-6206
  • Fax: 626-396-0851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA53390
License Number StateCA

VIII. Authorized Official

Name: DR. JOHNNY L. TRIPLETT
Title or Position: PRESIDENT
Credential: MD
Phone: 661-203-3186