Provider Demographics
NPI:1306281027
Name:JOHNSON, RYAN AARON (AUD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:AARON
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 BROOKES AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5138
Mailing Address - Country:US
Mailing Address - Phone:858-610-7808
Mailing Address - Fax:
Practice Address - Street 1:4190 BONITA RD STE 104
Practice Address - Street 2:
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-1330
Practice Address - Country:US
Practice Address - Phone:619-961-9130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist