Individual
MISS CAROL THERESA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RADT
Contact information
Practice address
79100 OCOTILLO DR, LA QUINTA, CA 92253-5915
(760) 834-8418
Mailing address
79100 OCOTILLO DR, LA QUINTA, CA 92253-5915
(760) 834-8418
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
R1523020823
CA
Other
Enumeration date
04/22/2024
Last updated
04/22/2024
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