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General NPI Number Information
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NPI Number | 1245028877
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Entity Type | Organization
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Legal Business Name | SANDRA JOHNSON PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/25/2025
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 1651 RESPONSE RD STE 350
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City | SACRAMENTO
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State | CA
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Zip | 95815-5255
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Country | US
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Telephone | 916-573-1372
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Fax |
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Provider Business Mailing Address
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Address Line | 1651 RESPONSE RD STE 350
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City | SACRAMENTO
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State | CA
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Zip | 95815-5255
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MABEL POWERS
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Credential |
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Telephone | 916-238-8945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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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 | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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