MEDICARE: JENNINFER L JOHNSON NP

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
1	363L00000X	Nurse Practitioner	NP16667	CA
2	363LA2100X	Acute Care Nurse Practitioner	RN 534139	CA
3	363LA2100X	Acute Care Nurse Practitioner	NP 16667	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508929225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNINFER L JOHNSON NP

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD
Second Line	:	STE 400
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:	310-794-1195
Fax Number	:

Provider Business Practice Location Address
First Line	:	1919 SANTA MONICA BLVD STE 300
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-1950
Country	:	US
Telephone Number	:	424-259-7160
Fax Number	:	424-259-7175

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	08/08/2014

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