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General NPI Number Information
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NPI Number | 1164332706
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Entity Type | Individual
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Provider Name | MATTIAS JOHANSSON
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Gender |
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Dates
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Enumeration Date | 09/08/2026
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Last Update Date | 09/08/2026
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Provider Practice Location Address
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Address Line | 401 PALOMA AVE
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City | PACIFICA
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State | CA
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Zip | 94044-2436
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Country | US
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Telephone | 650-550-7311
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Fax |
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Provider Business Mailing Address
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Address Line | 123 EDGEMONT DR BLDG A
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City | DALY CITY
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State | CA
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Zip | 94015-3868
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 250124044
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License Number State | CA
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