Basic Information
| Provider Information | |||||||||
| NPI: | 1437182151 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHRISTINE MARIE JOHNSTON MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 327 | ||||||||
| Address2: | |||||||||
| City: | FILLMORE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930160327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055242000 | ||||||||
| FaxNumber: | 8055249601 | ||||||||
| Practice Location | |||||||||
| Address1: | 552 SESPE AVE STE C | ||||||||
| Address2: | |||||||||
| City: | FILLMORE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930151954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055242000 | ||||||||
| FaxNumber: | 8055249601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSTON | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINE | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8055242000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | G77456 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | RHM08907F | 05 | CA | MEDICAID |