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NPI Code Detail

MEDICARE: SARA LIVINGSTON JOHNSON M.D.

MEDICARE: SARA LIVINGSTON JOHNSON M.D.
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
1207V00000XObstetrics & Gynecology PhysicianA 103367CA

General Provider Information

NPI Number : 1811125016
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARA LIVINGSTON JOHNSON M.D.
Provider Business Mailing Address
First Line : P.O. BOX 22210
Second Line :
City : OAKLAND
State : CA
Zip : 94623-2210
Country : US
Telephone Number : 510-504-8562
Fax Number :
Provider Business Practice Location Address
First Line : 3451 EAST 12TH ST
Second Line : TRANSIT VILLAGE WOMEN'S 2ND FLOOR
City : OAKLAND
State : CA
Zip : 94601-3425
Country : US
Telephone Number : 510-535-3377
Fax Number : 510-535-4248
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2009
Last Update Date : 03/08/2012

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