Individual
MR. LARRY WAYNE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.O.
Contact information
Practice address
9570 RIDGEHAVEN CT, SUITE C, SAN DIEGO, CA 92123-1667
(858) 278-0518
(858) 278-0323
Mailing address
10723 MONTEGO DR, SAN DIEGO, CA 92124-1910
(858) 565-2230
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
CO2834
CA
Other
Enumeration date
01/22/2009
Last updated
01/22/2009
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