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General NPI Number Information
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NPI Number | 1215743182
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Entity Type | Individual
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Provider Name | ANGELA JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 12/05/2024
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 10880 WILSHIRE BLVD SUITE 1101
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City | LOS ANGELES
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State | CA
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Zip | 90024
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Country | US
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Telephone | 310-420-0105
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 1357
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City | GLENDORA
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State | CA
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Zip | 91740
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Country | US
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Telephone | 310-420-1055
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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 | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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