Healthcare Provider Details

I. General information

NPI: 1861327504
Provider Name (Legal Business Name): MRS. SAMANTHA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 SAN BERNARDINO RD
UPLAND CA
91786-4920
US

IV. Provider business mailing address

333 E ARROW HWY
UPLAND CA
91785-7088
US

V. Phone/Fax

Practice location:
  • Phone: 909-636-7271
  • Fax:
Mailing address:
  • Phone: 909-636-7271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License NumberPICD00111125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: