MEDICARE: CEDRA 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	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1780549535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CEDRA JOHNSON

Provider Business Mailing Address
First Line	:	2545 N 83RD AVE APT 2180
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85035-2442
Country	:	US
Telephone Number	:	602-907-2067
Fax Number	:

Provider Business Practice Location Address
First Line	:	2545 N 83RD AVE APT 2180
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85035-2442
Country	:	US
Telephone Number	:	602-907-2067
Fax Number	:

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

Provider Enumeration Date	:	12/23/2025
Last Update Date	:	12/23/2025

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Directions to “ CEDRA JOHNSON ” Practice Location

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