Healthcare Provider Details

I. General information

NPI: 1437077989
Provider Name (Legal Business Name): ANDRIA JOHNSON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9925 INTERNATIONAL BLVD
OAKLAND CA
94603-2558
US

IV. Provider business mailing address

6249 HILTON ST
OAKLAND CA
94605-1446
US

V. Phone/Fax

Practice location:
  • Phone: 510-909-7566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: