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: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 EUCLID AVE STE 102
SAN DIEGO CA
92114-3611
US

IV. Provider business mailing address

286 EUCLID AVE
SAN DIEGO CA
92114-3610
US

V. Phone/Fax

Practice location:
  • Phone: 619-859-6270
  • Fax: 619-266-0496
Mailing address:
  • Phone: 619-859-6270
  • Fax: 619-266-0496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number20022
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: