Individual
BETH HAGERTY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7090 MIRATECH DR, SAN DIEGO, CA 92121-3109
(858) 304-6440
Mailing address
7090 MIRATECH DR, SAN DIEGO, CA 92121-3109
(858) 304-6440
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
0101255655
VA
208000000X
Pediatrics Physician
Primary
A161343
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/01/2012
Last updated
08/19/2019
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