Organization
CHC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MALIA JOHNSON DDS (CLINIC DIRECTOR)
(805) 929-3254
Entity
Organization
Contact information
Practice address
150 TEJAS PL, NIPOMO, CA 93444-9123
(805) 929-3254
Mailing address
1120 CALLE ATAPANEO, NIPOMO, CA 93444-7807
(805) 801-7883
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
63651
CA
Other
Enumeration date
10/11/2014
Last updated
10/11/2014
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