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NPI Code Detail

MEDICARE: IVAN ROSHAWIN JOHNSON

MEDICARE: IVAN ROSHAWIN JOHNSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist122126CA

General Provider Information

NPI Number : 1124226808
Entity Type Code : Individual
Provider Name (Legal Business Name) : IVAN ROSHAWIN JOHNSON
Provider Business Mailing Address
First Line : 840 N AVENUE 66
Second Line :
City : LOS ANGELES
State : CA
Zip : 90042-1508
Country : US
Telephone Number : 626-517-2368
Fax Number :
Provider Business Practice Location Address
First Line : 840 N AVENUE 66
Second Line :
City : LOS ANGELES
State : CA
Zip : 90042-1508
Country : US
Telephone Number : 240-762-8330
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2007
Last Update Date : 05/30/2026

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Directions to “ IVAN ROSHAWIN JOHNSON ” Practice Location

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