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General NPI Number Information
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NPI Number | 1932422003
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Entity Type | Organization
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Legal Business Name | FIRSTLINE HEALTH, INC.
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Dates
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Enumeration Date | 03/03/2010
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Last Update Date | 05/14/2013
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Provider Practice Location Address
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Address Line | 1023 PICO ST.
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City | SAN FERNANDO
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State | CA
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Zip | 91340
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Country | US
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Telephone | 818-838-1606
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Fax | 818-838-1699
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Provider Business Mailing Address
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Address Line | 4300 LONG BEACH BLVD. SUITE 170
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City | LONG BEACH
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State | CA
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Zip | 90807
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Country | US
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Telephone | 818-838-1606
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Fax | 818-838-1699
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID ROBERT JOHNSON
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Credential | M.D.
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Telephone | 818-838-1606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 565939350
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 565939350
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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