Healthcare Provider Details

I. General information

NPI: 1265710461
Provider Name (Legal Business Name): SHARON BEULAH JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2011
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 6295
TORRANCE CA
90504-0295
US

IV. Provider business mailing address

PO BOX 6295
TORRANCE CA
90504-0295
US

V. Phone/Fax

Practice location:
  • Phone: 310-347-6302
  • Fax:
Mailing address:
  • Phone: 310-347-6302
  • Fax: 310-347-6302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95038255
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: