MEDICARE: JOHNSON AND TASTO PARTNERSHIP

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	122300000X	Dentist	41135	CA

General Provider Information

NPI Number	:	1780086298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHNSON AND TASTO PARTNERSHIP

Provider Business Mailing Address
First Line	:	9420 MIRA MESA BLVD STE D
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-4848
Country	:	US
Telephone Number	:	858-695-1776
Fax Number	:	858-695-3769

Provider Business Practice Location Address
First Line	:	9420 MIRA MESA BLVD STE D
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-4848
Country	:	US
Telephone Number	:	858-695-1776
Fax Number	:	858-695-3769

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. JAMES PATRICK TASTO JR.
Credential	:	DDS
Telephone Number	:	858-695-1776

Provider Enumeration Date	:	09/16/2014
Last Update Date	:	09/16/2014

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