Healthcare Provider Details

I. General information

NPI: 1194471490
Provider Name (Legal Business Name): ZOE ELISE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 TEXAS ST STE 203
SAN DIEGO CA
92108-3723
US

IV. Provider business mailing address

5005 TEXAS ST STE 203
SAN DIEGO CA
92108-3723
US

V. Phone/Fax

Practice location:
  • Phone: 619-692-0727
  • Fax:
Mailing address:
  • Phone: 619-692-0727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: