Healthcare Provider Details

I. General information

NPI: 1578930202
Provider Name (Legal Business Name): ANGELA JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8470 ROSWELL ST
VENTURA CA
93004-2109
US

IV. Provider business mailing address

8470 ROSWELL ST
VENTURA CA
93004-2109
US

V. Phone/Fax

Practice location:
  • Phone: 805-746-1707
  • Fax:
Mailing address:
  • Phone: 805-746-1707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number95066935
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: