Healthcare Provider Details

I. General information

NPI: 1891490488
Provider Name (Legal Business Name): BETHBIREI JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 WILLOW PASS RD
CONCORD CA
94520-7928
US

IV. Provider business mailing address

2505 RACHEL CT
ANTIOCH CA
94531-8002
US

V. Phone/Fax

Practice location:
  • Phone: 925-288-3900
  • Fax: 925-646-5774
Mailing address:
  • Phone: 510-990-1450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number108657
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: