Healthcare Provider Details

I. General information

NPI: 1043787963
Provider Name (Legal Business Name): JOHANNA ANDREA LANCHEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 PLAZA DR STE 170
FOLSOM CA
95630-4790
US

IV. Provider business mailing address

1274 W BASELINE RD
CLAREMONT CA
91711-2152
US

V. Phone/Fax

Practice location:
  • Phone: 916-351-9400
  • Fax: 916-351-9449
Mailing address:
  • Phone: 909-293-6631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number815071
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number253245
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95038933
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: