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General NPI Number Information
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NPI Number | 1700061728
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Entity Type | Individual
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Provider Name | MR. JONATHAN EARL JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 01/09/2008
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Last Update Date | 01/09/2008
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Provider Practice Location Address
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Address Line | 2990 INLAND EMPIRE BLVD STE 101
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City | ONTARIO
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State | CA
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Zip | 91764-4899
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Country | US
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Telephone | 626-254-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 11704 DECLARATION DR
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-8225
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Country | US
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Telephone | 909-989-9221
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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