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General NPI Number Information
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NPI Number | 1013269182
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Entity Type | Organization
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Legal Business Name | RONALD M JOHNSON MD MEDICAL CORP
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Dates
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Enumeration Date | 10/12/2012
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Last Update Date | 10/12/2012
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Provider Practice Location Address
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Address Line | 5565 GROSSMONT CENTER DR
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City | LA MESA
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State | CA
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Zip | 91942-3020
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Country | US
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Telephone | 619-740-4145
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Fax | 619-740-4949
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Provider Business Mailing Address
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Address Line | PO BOX 2507
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City | LA MESA
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State | CA
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Zip | 91943-2507
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Country | US
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Telephone | 619-244-0884
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Fax | 619-704-2049
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | RONALD M JOHNSON
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Credential | M.D.
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Telephone | 619-244-0884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | G19831
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License Number State | CA
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