Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 20A7958 | CA |
NPI | 1669671673 |
---|---|
Provider Name | Dr. Virginia Marie Johnson |
First Address | Santa Monica, CA 90404-2756 |
Second Address | Santa Monica, CA 90404-2756 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2007 |
Last Update Date | 11/07/2007 |