Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | NPF 13309 | CA |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | NPF 13309 | CA |
NPI | 1003000837 |
---|---|
Provider Name | Richard L John JR. |
First Address | Santa Maria, CA 93254 |
Second Address | Santa Maria, CA 93454-4819 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2007 |
Last Update Date | 24/11/2014 |