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General NPI Number Information
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NPI Number | 1275723827
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Entity Type | Organization
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Legal Business Name | JAY A JOHNSON MD INC
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 11/18/2010
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Provider Practice Location Address
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Address Line | 1667 DOMINICAN WAY STE 230
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City | SANTA CRUZ
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State | CA
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Zip | 95065-1518
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Country | US
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Telephone | 831-464-3801
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Fax |
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Provider Business Mailing Address
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Address Line | 1667 DOMINICAN WAY STE 230
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City | SANTA CRUZ
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State | CA
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Zip | 95065-1518
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Country | US
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Telephone | 831-464-3801
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAY A JOHNSONMD
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Credential | MD
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Telephone | 831-464-3801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | G73261
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License Number State | CA
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