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General NPI Number Information
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NPI Number | 1487788899
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Entity Type | Organization
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Legal Business Name | SIERRA SPRING FAMILY WELLNESS CENTER
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 01/27/2010
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Provider Practice Location Address
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Address Line | 960 E GREEN ST SUITE 292
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City | PASADENA
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State | CA
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Zip | 91106-2401
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Country | US
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Telephone | 626-449-4494
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Fax | 626-449-4474
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Provider Business Mailing Address
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Address Line | 960 E GREEN ST SUITE 292
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City | PASADENA
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State | CA
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Zip | 91106-2401
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Country | US
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Telephone | 626-449-4494
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Fax | 626-449-4474
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Authorized Official
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Title or Position | PRESIDENT, CRAIG R. JOHNSON MD INC
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Name | DR. CRAIG RUSSELL JOHNSON
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Credential | M.D.
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Telephone | 626-449-4494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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