Healthcare Provider Details

I. General information

NPI: 1417005695
Provider Name (Legal Business Name): LORNA M JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2007
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 E FLORENCE AVE
LOS ANGELES CA
90001-2432
US

IV. Provider business mailing address

1201 E FLORENCE AVE
LOS ANGELES CA
90001-2432
US

V. Phone/Fax

Practice location:
  • Phone: 323-588-0084
  • Fax:
Mailing address:
  • Phone: 323-588-0084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN303602
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNMW1068
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberNMW1068
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: