Basic Information
| Provider Information | |||||||||
| NPI: | 1356645584 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | SAN JUAN | ||||||||
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| Credential: | R.C.P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 E JEFFERSON ST | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208524908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018162424 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6104 OLD BRANCH AVE | ||||||||
| Address2: | |||||||||
| City: | TEMPLE HILLS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207482518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017026335 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2011 | ||||||||
| LastUpdateDate: | 01/03/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 227800000X | L0005165 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified |
No ID Information.