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1396389334
COLLIN JOHANSEN
SAN DIEGO, CA
NPI
1396389334
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
171000000X Military Health Care Provider
Additional Taxonomies
363A00000X Physician Assistant
Enumeration Date
2019-11-02
Last Update Date
2019-11-02
Business Address
COLLIN JOHANSEN
4101 FARENHOLT AVE BLDG 14
SAN DIEGO, CA 92134-0001
Phone number: 469-570-8106
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Mailing Address
COLLIN JOHANSEN
SWMI
SAN DIEGO, CA 92134-0001
Phone number: 469-570-8106
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