Individual
MICHAEL JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
34101 FARENHOLT AVE, SAN DIEGO, CA 92134-7000
(281) 795-0620
Mailing address
17768 SENECA SPGS, COLLEGE STATION, TX 77845-3564
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
03/30/2020
Last updated
04/02/2020
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