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General NPI Number Information
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NPI Number | 1992522247
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Entity Type | Individual
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Provider Name | MILAN QUISHINA JOHNIGARN
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Gender | Female
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Dates
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Enumeration Date | 09/26/2024
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 2116 S CENTRAL AVE
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City | LOS ANGELES
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State | CA
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Zip | 90011-1237
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Country | US
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Telephone | 213-493-4664
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4262
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City | RIVERSIDE
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State | CA
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Zip | 92514-4262
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Country | US
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Telephone | 951-368-7165
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | R1486991122
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License Number State | CA
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