Healthcare Provider Details

I. General information

NPI: 1194523092
Provider Name (Legal Business Name): ROSA LETIYA ANN JOHNSON ED.D., ASW, RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 E 3RD ST STE C
LOS ANGELES CA
90013-1630
US

IV. Provider business mailing address

470 E 3RD ST STE C
LOS ANGELES CA
90013-1630
US

V. Phone/Fax

Practice location:
  • Phone: 213-620-5712
  • Fax:
Mailing address:
  • Phone: 213-620-5712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW129832
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number129832
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: