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General NPI Number Information
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NPI Number | 1730775933
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Entity Type | Individual
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Provider Name | EVAN JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 12/12/2020
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Last Update Date | 04/01/2024
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Provider Practice Location Address
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Address Line | 1971 E 4TH ST STE 200
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City | SANTA ANA
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State | CA
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Zip | 92705-3917
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Country | US
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Telephone | 888-959-5192
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Fax |
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Provider Business Mailing Address
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Address Line | 3102 JAMESON PASS
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City | ALPHARETTA
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State | GA
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Zip | 30022-3028
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Country | US
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Telephone | 562-677-4396
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA14256
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License Number State | TX
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