Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | G62317 | CA |
Y | 111NI0900X | Internist | G62317 | CA |
N | 207RC0200X | Critical Care Medicine | G62317 | CA |
N | 207RP1001X | Pulmonary Disease | G62317 | CA |
NPI | 1013962273 |
---|---|
Provider Name | Dr. Diane L. Johnson |
First Address | Long Beach, CA 90802-4718 |
Second Address | Long Beach, CA 90802-4718 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 07/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G623170 | (05) | CA |
00G623170 | BLUE SHIELD (01) | CA |
00G623170 | CALOPTIMA (01) | CA |
810000525 | GOOD SAM RAILROAD (01) | CA |
E29208 | (02) | CA |
G62317 | BLUE CROSS (01) | CA |