1275041295 NPI number — JOJI GALE MERCED JOHNS

Table of content: JOJI GALE MERCED JOHNS (NPI 1275041295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275041295 NPI number — JOJI GALE MERCED JOHNS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNS
Provider First Name:
JOJI GALE
Provider Middle Name:
MERCED
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275041295
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 SNEATH LN STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN BRUNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94066-2349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-244-1444
Provider Business Mailing Address Fax Number:
650-763-2366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 SNEATH LN STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN BRUNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-244-1444
Provider Business Practice Location Address Fax Number:
650-763-2366
Provider Enumeration Date:
01/11/2018

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: 101YA0400X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 38472 . This is a "THE LATINO COMMISSION ADMINISTRATION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 38472 . This is a "SUBSTANCE ABUSE COUNSELOR" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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