Individual
IVAN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
PO BOX 9212, FRESNO, CA 93791-9212
(209) 261-9991
Mailing address
PO BOX 9212, FRESNO, CA 93791-9212
(209) 261-9991
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
462930
CA
Other
Enumeration date
10/15/2024
Last updated
10/15/2024
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