MEDICARE: DR. OLUWATUMININU AYOTOKUNBO JOHNSON MD

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	207R00000X	Internal Medicine Physician	128874	CA

General Provider Information

NPI Number	:	1881882256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLUWATUMININU AYOTOKUNBO JOHNSON MD

Provider Business Mailing Address
First Line	:	2323 KNOLL DR STE 219
Second Line	:
City	:	VENTURA
State	:	CA
Zip	:	93003-7307
Country	:	US
Telephone Number	:	805-677-5312
Fax Number	:	805-677-5304

Provider Business Practice Location Address
First Line	:	1334 E MAIN ST
Second Line	:
City	:	SANTA PAULA
State	:	CA
Zip	:	93060-2926
Country	:	US
Telephone Number	:	805-933-1122
Fax Number	:	805-933-0522

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

Provider Enumeration Date	:	10/10/2007
Last Update Date	:	08/22/2014

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