Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 20A 10073 | CA |
NPI | 1013199124 |
---|---|
Provider Name | Dr. Matthew David Johnson |
First Address | Orange, CA 92868 |
Second Address | Orange, CA 92868 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2007 |
Last Update Date | 30/11/2007 |