Healthcare Provider Details

I. General information

NPI: 1720509086
Provider Name (Legal Business Name): MRS. ALLISHA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 06/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 YOLO ST
ORLAND CA
95963-1724
US

IV. Provider business mailing address

242 N VILLA AVE
WILLOWS CA
95988-2641
US

V. Phone/Fax

Practice location:
  • Phone: 530-865-6725
  • Fax: 530-865-6734
Mailing address:
  • Phone: 530-934-6582
  • Fax: 530-934-6592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: