Healthcare Provider Details

I. General information

NPI: 1558430538
Provider Name (Legal Business Name): RAMONA LYNN JOHNSON-HACKETT BS,RTC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD BLDG. 215
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

1341 GLEN AVE APT 1
PASADENA CA
91103-2527
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-3711
  • Fax:
Mailing address:
  • Phone: 626-797-1382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number4067-T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: