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General NPI Number Information
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NPI Number | 1013530310
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Entity Type | Individual
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Provider Name | MICAH JOHNSON RVT
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Gender | Male
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Dates
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Enumeration Date | 05/20/2020
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Last Update Date | 12/18/2021
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Provider Practice Location Address
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Address Line | 718 LEXINGTON AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78212-4768
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Country | US
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Telephone | 210-251-2024
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Fax | 210-742-9697
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Provider Business Mailing Address
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Address Line | 24165 IH 10 W STE 217747
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City | SAN ANTONIO
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State | TX
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Zip | 78257-1449
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Country | US
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Telephone | 210-251-2024
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Fax | 210-742-9697
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471V0105X
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Taxonomy Name | Vascular Sonography Radiologic Technologist
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License Number | 135818
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License Number State | TX
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