MEDICARE: NELIDA LARA 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
1	235Z00000X	Speech-Language Pathologist	25473	CA

General Provider Information

NPI Number	:	1639006539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NELIDA LARA JOHNSON

Provider Business Mailing Address
First Line	:	42905 SACHS DR
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93536-4814
Country	:	US
Telephone Number	:	661-965-1493
Fax Number	:

Provider Business Practice Location Address
First Line	:	42905 SACHS DR
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93536-4814
Country	:	US
Telephone Number	:	661-965-1493
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

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