Healthcare Provider Details

I. General information

NPI: 1063462125
Provider Name (Legal Business Name): CHRISTINA LOUISE JOHNSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 W 38TH AVE
WHEAT RIDGE CO
80033-6005
US

IV. Provider business mailing address

250 DAHLIA ST
DENVER CO
80220-5712
US

V. Phone/Fax

Practice location:
  • Phone: 303-425-2087
  • Fax:
Mailing address:
  • Phone: 303-393-7693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number33459
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01334598
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: