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General NPI Number Information
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NPI Number | 1669717450
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Entity Type | Organization
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Legal Business Name | NEW MILLENNIUM LAPAROSCOPY, P.C.
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Dates
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Enumeration Date | 12/05/2012
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Last Update Date | 12/05/2012
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Provider Practice Location Address
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Address Line | 237 ESTUDILLO AVE #209
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City | SAN LEANDRO
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State | CA
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Zip | 94577-4725
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Country | US
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Telephone | 510-926-6521
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Fax |
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Provider Business Mailing Address
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Address Line | 3984 WASHINGTON BLVD #344
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City | FREMONT
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State | CA
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Zip | 94538-4954
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Country | US
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Telephone | 510-926-6521
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALFRED B. JOHNSON
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Credential | M.D.
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Telephone | 510-926-6521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | G88950
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License Number State | CA
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