Healthcare Provider Details

I. General information

NPI: 1922326685
Provider Name (Legal Business Name): ALISHA RENEE JOHNSON PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11401 BLOOMFIELD AVE
NORWALK CA
90650-2015
US

IV. Provider business mailing address

1600 9TH ST STE 205
SACRAMENTO CA
95814-6435
US

V. Phone/Fax

Practice location:
  • Phone: 562-863-7011
  • Fax: 562-864-4560
Mailing address:
  • Phone: 916-654-2431
  • Fax: 916-654-3186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY23424
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: