Jeffrey M. Johnsrud, a Medical Corporation

Primary specialty

SpecialistTaxonomy code 174400000X

License

G51096 Issued in CA

Legal business name

JEFFREY M. JOHNSRUD, A MEDICAL CORPORATION

Practice address

1140 W la Veta Ave
Suite 760
Orange, CA 92868-4223

Phone

(714) 541-4442

Fax

(714) 835-9550

NPI assigned

Nov 3, 2010

Last updated

Mar 31, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Patricia Fuentes

Title

Credentialing

Phone

(714) 619-5450

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301529600000",
    "number": "1215238522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1140 W LA VETA AVE",
            "address_2": "SUITE 760",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928684223",
            "telephone_number": "714-541-4442",
            "fax_number": "714-835-9550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 W LA VETA AVE",
            "address_2": "SUITE 760",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928684223",
            "telephone_number": "714-541-4442",
            "fax_number": "714-835-9550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY M. JOHNSRUD, A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-03",
        "last_updated": "2011-03-31",
        "status": "A",
        "authorized_official_last_name": "FUENTES",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "714-619-5450"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G51096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiffany Jean, M.D.
• Mallory Jebbia, MD
• Ezekiel Micah Jefferson
• Jeffrey L Wu
• Jeffrey M. Dembner, MD, Inc.
• Jeffrey M. Shapiro, MD, Inc
• Jeffrey R Desantis DPM PC
• James C Jeng, MD
• Gary T Jenkins, MD
• Jeffrey A Jenkins, RPH

• Specialist in Orange, CA
• Providers in Orange, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.