Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | G55608 | CA |
NPI | 1013913722 |
---|---|
Provider Name | Dr. Ronald Bruce Johnson |
First Address | Los Angeles, CA 90033-2496 |
Second Address | Los Angeles, CA 90033-2496 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 13/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E68418 | (02) |