1073700787 NPI number — VICTORIA ELIZABETH JOHNSON CPHT

Table of content: VICTORIA ELIZABETH JOHNSON CPHT (NPI 1073700787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073700787 NPI number — VICTORIA ELIZABETH JOHNSON CPHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
VICTORIA
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
VICKY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CPHT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1073700787
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2502 N DODGE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85716-2671
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-901-6869
Provider Business Mailing Address Fax Number:
520-618-6730

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2502 N DODGE BLVD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-901-6869
Provider Business Practice Location Address Fax Number:
520-618-6730
Provider Enumeration Date:
09/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183700000X , with the licence number:  250101030353299 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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