Healthcare Provider Details

I. General information

NPI: 1295049229
Provider Name (Legal Business Name): CHRISTINE M. JOHNSON MSN, ANP-BC, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 EUCLID AVE PROJECT ENABLE WELLNESS & RECOVERY CTR
SAN DIEGO CA
92114
US

IV. Provider business mailing address

286 EUCLID AVE PROJECT ENABLE WELLNESS & RECOVERY CTR
SAN DIEGO CA
92114
US

V. Phone/Fax

Practice location:
  • Phone: 619-266-2111
  • Fax: 619-266-0496
Mailing address:
  • Phone: 619-266-2111
  • Fax: 619-266-0496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number526349
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number20022
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: