Provider Demographics
NPI:1043069685
Name:JOHNSON, ALVINCENT RAMONE
Entity type:Individual
Prefix:
First Name:ALVINCENT
Middle Name:RAMONE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:997 LAUREL CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-7066
Mailing Address - Country:US
Mailing Address - Phone:707-342-9368
Mailing Address - Fax:
Practice Address - Street 1:997 LAUREL CREEK WAY
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-7066
Practice Address - Country:US
Practice Address - Phone:707-342-9368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty