Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | A86357 | CA |
NPI | 1669495370 |
---|---|
Provider Name | Miss Samantha Hunter Johnston |
First Address | Berkeley, CA 94708-1218 |
Second Address | Oakland, CA 94609-1809 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 09/01/2020 |