Most Relevant Information
Provider Data
| NPI Number: | 1003599986 |
| Provider Name: | SAMANTHA N JOHANSEN RD |
| Entity Type: | Individual |
| Taxonomy Code: | 133V00000X |
| Specialty: | Dietitian, Registered |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/08/2023 |
| Last Updated: | 08/11/2023 |
Provider Practice Location
2741 A ST APT H
SAN DIEGO
CA
921027023
Practice Location Phone/Fax
| Phone: | 6196075536 |
| Fax: |
Provider Mailing Location
2741 A ST APT H
SAN DIEGO
CA
921027023
Provider Mailing Phone/Fax
| Phone: | 6196075536 |
| Fax: |