Healthcare Provider Details

I. General information

NPI: 1649188327
Provider Name (Legal Business Name): DEANNA ASHANTI JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 CARNEGIE AVE
SANTA ANA CA
92705-5504
US

IV. Provider business mailing address

18112 RAYMOND CT
FONTANA CA
92336-2391
US

V. Phone/Fax

Practice location:
  • Phone: 800-273-4292
  • Fax:
Mailing address:
  • Phone: 909-618-9836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: