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General NPI Number Information
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NPI Number | 1801940689
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Entity Type | Individual
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Provider Name | BRUCE BOWER JOHNSTON PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 30100 CROWN VALLEY PKWY SUITE 17
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-2041
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Country | US
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Telephone | 949-224-9072
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Fax | 949-429-8723
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Provider Business Mailing Address
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Address Line | 26000 AVENIDA AEROPUERTO #216
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-4720
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Country | US
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Telephone | 949-224-9072
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Fax | 949-429-8723
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY14156
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License Number State | CA
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