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NPI Code Detail

MEDICARE: ANGELA JOHANSSON DO

MEDICARE: ANGELA JOHANSSON DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician4233AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14233OTHERAZSTATE LICENSE

General Provider Information

NPI Number : 1295739985
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA JOHANSSON DO
Provider Business Mailing Address
First Line : 15351 W BELL RD
Second Line :
City : SURPRISE
State : AZ
Zip : 85374-4580
Country : US
Telephone Number : 877-809-5092
Fax Number : 623-214-5231
Provider Business Practice Location Address
First Line : 15351 W BELL RD
Second Line :
City : SURPRISE
State : AZ
Zip : 85374-4580
Country : US
Telephone Number : 877-809-5092
Fax Number : 623-214-5231
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 02/03/2012

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