Collin Johansen, is a medicare enrolled "Military Health Care Provider" in San Diego, California. His current practice location is
4101 Farenholt Ave Bldg 14, San Diego, California. You can reach out to his office (for appointments etc.) via phone at
(469) 570-8106.
Collin Johansen is licensed to practice in * (Not Available) (license number ) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1396389334.
Provider's Profile
| Full Name | Collin Johansen |
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| Gender | Male |
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| Speciality | Military Health Care Provider |
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| Location | 4101 Farenholt Ave Bldg 14, San Diego, California |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1396389334
- Provider Enumeration Date: 11/02/2019
- Last Update Date: 11/02/2019
Medicare PECOS Information:
- PECOS PAC ID: 1254714660
- Enrollment ID: I20220818000252
Medical Identifiers
Medical identifiers for Collin Johansen such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1396389334 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363A00000X | Physician Assistant | (* (Not Available)) | Secondary |
| 171000000X | Military Health Care Provider | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Collin Johansen is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Collin Johansen,
Swmi,
San Diego, CA 92134-0001
Ph: (469) 570-8106 | Collin Johansen,
4101 Farenholt Ave Bldg 14,
San Diego, CA 92134-0001
Ph: (469) 570-8106 |
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