Healthcare Provider Details

I. General information

NPI: 1164296760
Provider Name (Legal Business Name): REBECCA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2029 KEITH ST
LINCOLN HEIGHTS CA
90031-3128
US

IV. Provider business mailing address

2029 KEITH ST
LINCOLN HEIGHTS CA
90031-3128
US

V. Phone/Fax

Practice location:
  • Phone: 213-721-0010
  • Fax:
Mailing address:
  • Phone: 818-985-8323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: