Healthcare Provider Details

I. General information

NPI: 1821993072
Provider Name (Legal Business Name): TAMIA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 W 190TH ST STE 250
GARDENA CA
90248-4305
US

IV. Provider business mailing address

17923 LYSANDER DR
CARSON CA
90746-1625
US

V. Phone/Fax

Practice location:
  • Phone: 310-878-3949
  • Fax:
Mailing address:
  • Phone: 310-528-1783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: