Basic Information
| Provider Information | |||||||||
| NPI: | 1538266481 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | HERNDON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1048 VIA MIL CUMBRES | ||||||||
| Address2: | |||||||||
| City: | SOLANA BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920751723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582590126 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3156 VISTA WAY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920563622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7605478000 | ||||||||
| FaxNumber: | 7605478001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 03/05/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | C33577 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.