=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275509283
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MONICA LYNNE JOHNSON D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2006
-----------------------------------------------------
Last Update Date | 11/20/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3746 SCHERTZ PKWY
-----------------------------------------------------
City | SCHERTZ
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78154-2928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-654-0944
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 536 SADDLE VIS
-----------------------------------------------------
City | CIBOLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78108-3658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-752-1535
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 3309
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207K00000X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology Physician
-----------------------------------------------------
License Number | S4162
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------