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NPI Code Detail

MEDICARE: JACQUELINE JOHNSON PA-C

MEDICARE: JACQUELINE JOHNSON PA-C
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
1363A00000XPhysician Assistant10005083AIN
2363A00000XPhysician AssistantPA22120CA

General Provider Information

NPI Number : 1356617021
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE JOHNSON PA-C
Provider Business Mailing Address
First Line : PO BOX 512185
Second Line :
City : LOS ANGELES
State : CA
Zip : 90051-0185
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1500 DUARTE RD
Second Line :
City : DUARTE
State : CA
Zip : 91010-3012
Country : US
Telephone Number : 626-256-4673
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2012
Last Update Date : 12/12/2025

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Directions to “ JACQUELINE JOHNSON PA-C” Practice Location

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