| Craig R. Johnson, M.d., Inc. | |
|
960 E Green St Suite 292 Pasadena CA 91106-2412 | |
| (626) 449-4494 | |
| (626) 449-4474 |
| Full Name | Craig R. Johnson, M.d., Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 960 E Green St, Pasadena, California |
| Authorized Official Name and Position | Craig R Johnson (PRESIDENT) |
| Authorized Official Contact | 6264494494 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Craig R. Johnson, M.d., Inc. Po Box 730 Upland CA 91785-0730 Ph: () - | Craig R. Johnson, M.d., Inc. 960 E Green St Suite 292 Pasadena CA 91106-2412 Ph: (626) 449-4494 |
| NPI Number | 1578962825 |
|---|---|
| Provider Enumeration Date | 08/21/2014 |
| Last Update Date | 02/17/2015 |
| Medicare PECOS PAC ID | 2466405899 |
|---|---|
| Medicare Enrollment ID | O20150212001667 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578962825 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | G72241 (California) | Primary |
| Provider Name | Craig Russell Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336191063 PECOS PAC ID: 4082667415 Enrollment ID: I20050228000117 |
| Provider Name | Sharon Li Kirchheimer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528372620 PECOS PAC ID: 5496044349 Enrollment ID: I20160516001451 |
| Provider Name | Jodi Michelle Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467056184 PECOS PAC ID: 3870970718 Enrollment ID: I20220516002141 |
| Provider Name | Trisha Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518613033 PECOS PAC ID: 4688041403 Enrollment ID: I20221108003133 |
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