1477882280 NPI number — ERIKA LYNEE JOHNSON P.T.

Table of content: ERIKA LYNEE JOHNSON P.T. (NPI 1477882280)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477882280 NPI number — ERIKA LYNEE JOHNSON P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
ERIKA
Provider Middle Name:
LYNEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OKARSKI
Provider Other First Name:
ERIKA
Provider Other Middle Name:
LYNEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477882280
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3400 CALLOWAY DR STE 603
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93312-2514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-377-1700
Provider Business Mailing Address Fax Number:
661-616-9199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11206 OLIVE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-377-1700
Provider Business Practice Location Address Fax Number:
661-616-9199
Provider Enumeration Date:
12/08/2009

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: 225100000X , with the licence number:  36158 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DE5473 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com