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General NPI Number Information
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NPI Number | 1760860357
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Entity Type | Individual
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Provider Name | CALI ELYSE JOHNSON MD
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Gender | Female
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Dates
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Enumeration Date | 05/14/2015
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Last Update Date | 10/25/2021
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Provider Practice Location Address
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Address Line | 1520 SAN PABLO ST HCT 4300
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City | LOS ANGELES
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State | CA
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Zip | 90033-5310
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Country | US
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Telephone | 323-442-5876
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Fax |
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Provider Business Mailing Address
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Address Line | 1520 SAN PABLO ST HCT 4300
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City | LOS ANGELES
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State | CA
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Zip | 90033-5310
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Country | US
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Telephone |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 135994
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 12250467-1205
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License Number State | UT
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