Healthcare Provider Details

I. General information

NPI: 1124097779
Provider Name (Legal Business Name): LISA JOHNSTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10672 WEXFORD ST STE 200
SAN DIEGO CA
92131-3974
US

IV. Provider business mailing address

1400 E PALOMAR ST
CHULA VISTA CA
91913-1800
US

V. Phone/Fax

Practice location:
  • Phone: 734-218-0757
  • Fax:
Mailing address:
  • Phone: 858-499-2702
  • Fax: 619-397-3378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301065907
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA105006
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: