Healthcare Provider Details

I. General information

NPI: 1720358476
Provider Name (Legal Business Name): MS. JULIE KAY JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 MERCURY WAY STE 107
SANTA ROSA CA
95407-5472
US

IV. Provider business mailing address

2235 MERCURY WAY STE 107
SANTA ROSA CA
95407-5472
US

V. Phone/Fax

Practice location:
  • Phone: 707-571-5581
  • Fax: 707-571-5531
Mailing address:
  • Phone: 707-571-5581
  • Fax: 707-571-5531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: