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General NPI Number Information
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NPI Number | 1104910306
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Entity Type | Individual
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Provider Name | DAVID SCOTT JOHNSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 09/25/2023
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Provider Practice Location Address
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Address Line | 49305 GRAPEFRUIT BLVD STE 1
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City | COACHELLA
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State | CA
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Zip | 92236-1490
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Country | US
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Telephone | 760-398-0723
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Fax |
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Provider Business Mailing Address
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Address Line | 31938 TEMECULA PKWY STE A337
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City | TEMECULA
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State | CA
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Zip | 92592-6810
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Country | US
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Telephone |
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Fax | 760-398-0723
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 12949
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A88275
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License Number State | CA
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