Healthcare Provider Details

I. General information

NPI: 1306427984
Provider Name (Legal Business Name): PEDRO L JOHNSON INTERPRETER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 NE 112TH AVE STE 103
VANCOUVER WA
98684-5114
US

IV. Provider business mailing address

PO BOX 132
VANCOUVER WA
98666-0132
US

V. Phone/Fax

Practice location:
  • Phone: 360-597-9302
  • Fax: 360-597-2647
Mailing address:
  • Phone: 360-597-9302
  • Fax: 360-597-2647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: