Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | MD25475 | OR |
NPI | 1336105386 |
---|---|
Provider Name | Dr. Mickaila J Johnston |
First Address | San Diego, CA 92134-1098 |
Second Address | San Diego, CA 92134-1098 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 12/05/2014 |