Healthcare Provider Details

I. General information

NPI: 1215892856
Provider Name (Legal Business Name): DR. NICOLE DAVIS- DAVIS-JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NIKI JOHNSON

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 W ORANGE GROVE AVE
POMONA CA
91768-2848
US

IV. Provider business mailing address

1340 W ORANGE GROVE AVE
POMONA CA
91768-2848
US

V. Phone/Fax

Practice location:
  • Phone: 954-702-5703
  • Fax: 718-864-3642
Mailing address:
  • Phone: 954-702-5703
  • Fax: 718-864-3642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: