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General NPI Number Information
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NPI Number | 1508476730
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Entity Type | Individual
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Provider Name | DAMARIA ANTIONETTE JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 08/03/2020
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 1215 ARMORLITE DR APT 120
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City | SAN MARCOS
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State | CA
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Zip | 92069-1397
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Country | US
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Telephone | 213-910-9174
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Fax |
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Provider Business Mailing Address
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Address Line | 960 POSTAL WAY # 1690
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City | VISTA
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State | CA
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Zip | 92083-6915
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Country | US
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Telephone | 213-910-9174
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Fax |
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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 | 172A00000X
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Taxonomy Name | Driver
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License Number | F4286983
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License Number State | CA
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