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Individual

DR. DIANE L. JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
65 PINE AVE, #19, LONG BEACH, CA 90802-4718
(714) 402-4685
(562) 856-0389
Mailing address
65 PINE AVE, #19, LONG BEACH, CA 90802-4718
(714) 402-4685
(562) 856-0389

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
G62317
CA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
G62317
CA
207RP1001X
Pulmonary Disease Physician
G62317
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00G623170
CALOPTIMA
CA
05
00G623170
CA
01
810000525
GOOD SAM RAILROAD
CA
01
G62317
BLUE CROSS
CA
Enumeration date
05/24/2006
Last updated
05/07/2009
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