Provider Demographics
NPI:1669543914
Name:DANNY JOHNSON
Entity type:Organization
Organization Name:DANNY JOHNSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C, LAC
Authorized Official - Phone:831-566-8236
Mailing Address - Street 1:PO BOX 1734
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95061-1734
Mailing Address - Country:US
Mailing Address - Phone:831-566-8236
Mailing Address - Fax:866-614-3886
Practice Address - Street 1:4140 JADE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-3956
Practice Address - Country:US
Practice Address - Phone:831-464-7246
Practice Address - Fax:831-464-7744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21442363AM0700X
CA9587171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty