Healthcare Provider Details

I. General information

NPI: 1760214613
Provider Name (Legal Business Name): JERLIN ISHMIN JOHNSON UNIT CLERK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 E 6TH ST
LONG BEACH CA
90802-1402
US

IV. Provider business mailing address

2254 S BRONSON AVE
LOS ANGELES CA
90018-1060
US

V. Phone/Fax

Practice location:
  • Phone: 562-435-7350
  • Fax: 844-662-1120
Mailing address:
  • Phone: 831-756-0737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: