Healthcare Provider Details

I. General information

NPI: 1306988746
Provider Name (Legal Business Name): CALIFORNIA OCCUPATIONAL MEDICINE PRACTICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 ROSE AVENUE
SELMA CA
93662
US

IV. Provider business mailing address

PO BOX 52060
PACIFIC GROVE CA
93950
US

V. Phone/Fax

Practice location:
  • Phone: 559-891-8940
  • Fax:
Mailing address:
  • Phone: 831-901-6856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License NumberA79547
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberA79547
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA79547
License Number StateCA

VIII. Authorized Official

Name: MARC DOUGLASS JOHNSON
Title or Position: CEO
Credential: MD
Phone: 831-901-6856