Healthcare Provider Details

I. General information

NPI: 1205740651
Provider Name (Legal Business Name): CHARLES H JOHNSON JR. CALMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 W LANCASTER BLVD STE 12
LANCASTER CA
93534-2506
US

IV. Provider business mailing address

12901 PROFITT ST
NORTH EDWARDS CA
93523-3445
US

V. Phone/Fax

Practice location:
  • Phone: 661-794-3668
  • Fax:
Mailing address:
  • Phone: 661-794-3668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number35189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: