Healthcare Provider Details

I. General information

NPI: 1659519601
Provider Name (Legal Business Name): ALYSHA EVELINA HENRY-JOHNSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSHA EVELINA JOHNSON PA-C

II. Dates (important events)

Enumeration Date: 01/29/2009
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1971 E 4TH ST STE 200
SANTA ANA CA
92705-3917
US

IV. Provider business mailing address

1190 NW 166TH AVE
PEMBROKE PINES FL
33028-1341
US

V. Phone/Fax

Practice location:
  • Phone: 888-959-5192
  • Fax:
Mailing address:
  • Phone: 754-777-0794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9104903
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: