Provider Demographics
NPI:1053419440
Name:JOHNSON, CHRIS DEAN (MD)
Entity type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:DEAN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1786 OCEAN OAKS RD
Mailing Address - Street 2:
Mailing Address - City:CARPINTERIA
Mailing Address - State:CA
Mailing Address - Zip Code:93013-3025
Mailing Address - Country:US
Mailing Address - Phone:805-652-5011
Mailing Address - Fax:805-585-3007
Practice Address - Street 1:147 N BRENT ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2809
Practice Address - Country:US
Practice Address - Phone:805-652-5011
Practice Address - Fax:805-585-3007
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67760146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA050394OtherBLUE CROSS
CAA67760OtherLICENSE NUMBER
CAZZZA56032OtherBLUE SHIELD
CAHSC30394FMedicaid
CAZZZ53994ZOtherBLUE SHIELD
CAZZT40394FMedicaid
CAZZZ53994ZOtherBLUE SHIELD
CAA67760OtherLICENSE NUMBER
CAZZT40394FMedicaid