Healthcare Provider Details

I. General information

NPI: 1467731778
Provider Name (Legal Business Name): THOMAS HENRY JOHNSON RES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TORRENCE HENRY JOHNSON RES

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 E AVENUE J7
LANCASTER CA
93535-3644
US

IV. Provider business mailing address

345 E AVENUE J7
LANCASTER CA
93535-3644
US

V. Phone/Fax

Practice location:
  • Phone: 661-942-9770
  • Fax: 661-942-9770
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: