MEDICARE: ZACHARY ALLEN 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
1	363AM0700X	Medical Physician Assistant		CA
2	363A00000X	Physician Assistant	55938	CA

General Provider Information

NPI Number	:	1598233256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY ALLEN JOHNSON PA-C

Provider Business Mailing Address
First Line	:	550 DEEP VALLEY DR STE 283
Second Line	:
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-7602
Country	:	US
Telephone Number	:	424-235-6225
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 DEEP VALLEY DR STE 283
Second Line	:
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-7602
Country	:	US
Telephone Number	:	424-235-6225
Fax Number	:

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

Provider Enumeration Date	:	11/10/2018
Last Update Date	:	11/10/2018

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