MEDICARE: SIDONA JOHNSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1093067092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIDONA JOHNSON

Provider Business Mailing Address
First Line	:	6166 S SANDHILL RD STE 132
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3221
Country	:	US
Telephone Number	:	702-534-1044
Fax Number	:	702-534-1121

Provider Business Practice Location Address
First Line	:	6166 S SANDHILL RD STE 132
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3221
Country	:	US
Telephone Number	:	702-534-1044
Fax Number	:	702-534-1121

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2012
Last Update Date	:	10/15/2012

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Directions to “ SIDONA JOHNSON ” Practice Location

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