Healthcare Provider Details

I. General information

NPI: 1881260693
Provider Name (Legal Business Name): VANESSA ANN JOHNSON LMT, CAHC, CHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32505 CANDLEWOOD DR UNIT 10
CATHEDRAL CITY CA
92234-3940
US

IV. Provider business mailing address

32505 CANDLEWOOD DR UNIT 10
CATHEDRAL CITY CA
92234-3940
US

V. Phone/Fax

Practice location:
  • Phone: 760-895-0680
  • Fax:
Mailing address:
  • Phone: 760-895-0680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14830
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: