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General NPI Number Information
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NPI Number | 1043823461
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Entity Type | Individual
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Provider Name | CRYSTAL D JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 08/25/2020
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Last Update Date | 04/10/2022
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Provider Practice Location Address
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Address Line | 11140 JEFFERSON BLVD STE 7
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City | CULVER CITY
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State | CA
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Zip | 90230-5522
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Country | US
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Telephone | 310-428-8309
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Fax |
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Provider Business Mailing Address
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Address Line | 10736 JEFFERSON BLVD # 775
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City | CULVER CITY
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State | CA
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Zip | 90230-4933
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Country | US
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Telephone | 310-428-8309
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Fax |
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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 | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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