Individual
CHARLES JOHNSON ETHELBAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CMPSS
Contact information
Practice address
1777 BUCKMAN SPRINGS RD, CAMPO, CA 91906-2022
(619) 478-5696
Mailing address
1777 BUCKMAN SPRINGS RD, CAMPO, CA 91906-2022
(619) 478-5696
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
MPSS-ZKDUCT
CA
Other
Enumeration date
10/07/2025
Last updated
10/07/2025
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