Individual
MR. STEPHAN LEE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4060 FAIRMOUNT AVE, SAN DIEGO, CA 92105-1608
(619) 280-4213
(619) 280-3545
Mailing address
4060 FAIRMOUNT AVE, SAN DIEGO, CA 92105-1608
(619) 280-4213
(619) 280-3545
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA16986
CA
Other
Enumeration date
11/06/2009
Last updated
12/27/2011
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