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General NPI Number Information
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NPI Number | 1508550864
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Entity Type | Individual
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Provider Name | DYLAN KEAHI JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 06/07/2023
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Last Update Date | 06/07/2023
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Provider Practice Location Address
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Address Line | 1803 SANTA MARGARITA DR
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City | FALLBROOK
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State | CA
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Zip | 92028-1644
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Country | US
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Telephone | 310-292-1153
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Fax |
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Provider Business Mailing Address
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Address Line | 1803 SANTA MARGARITA DR
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City | FALLBROOK
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State | CA
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Zip | 92028-1644
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Country | US
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Telephone | 310-292-1153
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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