NPI 1659782787

Russell Laroy Johnson

Practitioner Contractor Fontana, CA

Practice location

Address: 11629 Sueno CT., Fontana, CA 92337
Phone: (323) 801-9208

Registered specialties

Contractor Primary

Other Service Providers Taxonomy 171W00000X

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Registry record

NPI: 1659782787
Entity type: Individual
Sex (as registered): Male
NPI issued: 12 May 2014
Record last updated: 12 May 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.