Healthcare Provider Details

I. General information

NPI: 1720660228
Provider Name (Legal Business Name): BENJAMIN JOSEPH JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N PALM CANYON DR STE A1-A4
PALM SPRINGS CA
92262-1868
US

IV. Provider business mailing address

3625 14TH ST
RIVERSIDE CA
92501-3815
US

V. Phone/Fax

Practice location:
  • Phone: 760-424-5602
  • Fax:
Mailing address:
  • Phone: 760-660-5785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number135624
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: