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General NPI Number Information
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NPI Number | 1528212545
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Entity Type | Individual
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Provider Name | RONDERICK JOHNSON JR. M.S.
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Gender | Male
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Dates
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Enumeration Date | 11/05/2008
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Last Update Date | 10/10/2018
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Provider Practice Location Address
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Address Line | 679 S NEW HAMPSHIRE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90005-1355
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Country | US
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Telephone | 213-385-5100
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Fax | 213-807-1995
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Provider Business Mailing Address
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Address Line | 1501 HUGHES WAY STE 150
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City | LONG BEACH
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State | CA
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Zip | 90810-1878
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Country | US
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Telephone | 310-221-6336
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Fax | 310-221-6350
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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