Healthcare Provider Details

I. General information

NPI: 1780136853
Provider Name (Legal Business Name): LATOYA SMITHJOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 ATLANTIC AVE
ALAMEDA CA
94501-1148
US

IV. Provider business mailing address

368 FELL ST
SAN FRANCISCO CA
94102-5144
US

V. Phone/Fax

Practice location:
  • Phone: 510-924-7667
  • Fax:
Mailing address:
  • Phone: 415-861-0828
  • Fax: 415-861-0257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number227929
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: