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General NPI Number Information
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NPI Number | 1265023402
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Entity Type | Individual
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Provider Name | ELORA PATRICE SAN JUAN JOHNSON MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/31/2021
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 10775 PIONEER TRL STE 215
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City | TRUCKEE
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State | CA
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Zip | 96161-0234
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Country | US
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Telephone | 415-424-4266
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Fax | 415-520-6633
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Provider Business Mailing Address
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Address Line | 8300 ESTERS BLVD STE 900
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City | IRVING
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State | TX
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Zip | 75063-2233
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Country | US
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Telephone | 415-424-4266
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Fax | 415-520-6633
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW22385
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 94668
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License Number State | CA
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