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Individual

MS. IVY M. JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
2720 N HARBOR BLVD STE 210, FULLERTON, CA 92835-2626
(714) 446-5192
(714) 515-8360
Mailing address
2720 N HARBOR BLVD STE 210, FULLERTON, CA 92835-2626
(714) 446-5192
(714) 515-8360

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA15987
CA
363AS0400X
Surgical Physician Assistant
Primary
PA 15987
CA

Other

Enumeration date
01/16/2007
Last updated
01/15/2020
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