=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619904760
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDITH ANN JOHNSON N.P.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 S FRANCISCA AVE #4
-----------------------------------------------------
City | REDONDO BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90277-3354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-292-1303
-----------------------------------------------------
Fax | 310-372-7874
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 205 S FRANCISCA AVE #4
-----------------------------------------------------
City | REDONDO BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90277-3354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-292-1303
-----------------------------------------------------
Fax | 310-372-7874
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | NP9652 RN511482
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------