Provider Demographics
NPI:1285000257
Name:JOHNSON, MEGAN MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:MIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2080 CENTURY PARK E STE 1806
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2021
Mailing Address - Country:US
Mailing Address - Phone:210-551-1711
Mailing Address - Fax:
Practice Address - Street 1:2080 CENTURY PARK E STE 1806
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2021
Practice Address - Country:US
Practice Address - Phone:210-551-1711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52648363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical