Healthcare Provider Details

I. General information

NPI: 1275777823
Provider Name (Legal Business Name): JOHNSON FIRST CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 FRUSSEL #278
LOS ANGLES CA
90211-3577
US

IV. Provider business mailing address

1234 FRUSSEL #278
LOS ANGLES CA
90211-3577
US

V. Phone/Fax

Practice location:
  • Phone: 302-290-4662
  • Fax:
Mailing address:
  • Phone: 302-290-4662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License NumberA41528
License Number StateCA

VIII. Authorized Official

Name: ALFRED M SMITH
Title or Position: PRESIDENT
Credential: MD
Phone: 302-290-4662