Healthcare Provider Details

I. General information

NPI: 1518138098
Provider Name (Legal Business Name): ROBERT ALLEN JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PRISON RD
REPRESA CA
95671-3000
US

IV. Provider business mailing address

100 PRISON RD P.O. BOX 290012
REPRESA CA
95671-3000
US

V. Phone/Fax

Practice location:
  • Phone: 916-985-8610
  • Fax: 916-294-3018
Mailing address:
  • Phone: 916-985-8610
  • Fax: 916-294-3018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG42325
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: