Healthcare Provider Details

I. General information

NPI: 1083526974
Provider Name (Legal Business Name): LESLEY JOHNSON NMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 GRAND AVE
OAKLAND CA
94610-2042
US

IV. Provider business mailing address

2636 LOGAN ST
OAKLAND CA
94601-1923
US

V. Phone/Fax

Practice location:
  • Phone: 510-274-7849
  • Fax:
Mailing address:
  • Phone: 510-274-7849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number101300
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: