Provider Demographics
NPI:1699920579
Name:JOHNSON'S ORTHOPEDIC
Entity type:Organization
Organization Name:JOHNSON'S ORTHOPEDIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:LESLI
Authorized Official - Middle Name:D
Authorized Official - Last Name:KEARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-785-4411
Mailing Address - Street 1:7254 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-3829
Mailing Address - Country:US
Mailing Address - Phone:951-785-4411
Mailing Address - Fax:951-785-4665
Practice Address - Street 1:24335 PRIELIPP RD
Practice Address - Street 2:SUITE 118
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7426
Practice Address - Country:US
Practice Address - Phone:877-483-2522
Practice Address - Fax:951-785-4665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1487748059OtherMEDI-CAL
CA0210910001Medicare NSC