Individual
BLAIR R JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
420 W ROWLAND ST, COVINA, CA 91723-2943
(626) 331-6411
(626) 251-1560
Mailing address
420 W ROWLAND ST, COVINA, CA 91723-2943
(626) 331-6411
(626) 251-1560
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA11436
CA
363AM0700X
Medical Physician Assistant
Primary
PA11436
CA
363AS0400X
Surgical Physician Assistant
PA11436
CA
Other
Enumeration date
04/14/2006
Last updated
10/14/2020
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