Individual
ROBERT GARY JOHANNSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2731 NUGGET AVE, LAKE ISABELLA, CA 93240-9456
(760) 379-3412
(760) 379-5332
Mailing address
2731 NUGGET AVE, LAKE ISABELLA, CA 93240-9456
(760) 379-3412
(760) 379-5332
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
MPSS-EKZJXM
CA
Other
Enumeration date
11/06/2025
Last updated
11/06/2025
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