Healthcare Provider Details

I. General information

NPI: 1578340477
Provider Name (Legal Business Name): ROBIN ELLEN JOHNSON MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 INLAND EMPIRE BLVD
ONTARIO CA
91764-4898
US

IV. Provider business mailing address

720 BRIARWOOD LN
SAN DIMAS CA
91773-3609
US

V. Phone/Fax

Practice location:
  • Phone: 909-458-1350
  • Fax:
Mailing address:
  • Phone: 626-485-5923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number23235
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: