Healthcare Provider Details

I. General information

NPI: 1447520572
Provider Name (Legal Business Name): JOHNSON SURGICAL ASSIST ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 01/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 TULLY RD STE A2
SAN JOSE CA
95122-4237
US

IV. Provider business mailing address

1075 TULLY RD STE A2
SAN JOSE CA
95122-4237
US

V. Phone/Fax

Practice location:
  • Phone: 408-440-2359
  • Fax: 408-677-4941
Mailing address:
  • Phone: 408-440-2359
  • Fax: 408-677-4941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DONNELLE J DUBOIS
Title or Position: DIRECTOR
Credential:
Phone: 408-440-2359