Healthcare Provider Details

I. General information

NPI: 1770683658
Provider Name (Legal Business Name): LIBRE JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 TREAT BLVD STE 250A
WALNUT CREEK CA
94597-2168
US

IV. Provider business mailing address

1450 TREAT BLVD STE 300
WALNUT CREEK CA
94597-2168
US

V. Phone/Fax

Practice location:
  • Phone: 925-296-9706
  • Fax: 925-296-9062
Mailing address:
  • Phone: 925-952-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA76860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: