Healthcare Provider Details

I. General information

NPI: 1972835304
Provider Name (Legal Business Name): AARON JOSEPH JOHNSON BA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2010
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 IOWA AVE STE 3
RIVERSIDE CA
92507-0509
US

IV. Provider business mailing address

325 W HOSPITALITY LN STE 103
SAN BERNARDINO CA
92408-3210
US

V. Phone/Fax

Practice location:
  • Phone: 909-266-2792
  • Fax:
Mailing address:
  • Phone: 951-278-8058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: