MEDICARE: DOMINIQUE 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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1649143025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIQUE JOHNSON

Provider Business Mailing Address
First Line	:	13 DOE CT
Second Line	:
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-4652
Country	:	US
Telephone Number	:	323-427-3296
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 DOE CT
Second Line	:
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-4652
Country	:	US
Telephone Number	:	323-427-3296
Fax Number	:

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

Provider Enumeration Date	:	09/24/2025
Last Update Date	:	09/24/2025

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Directions to “ DOMINIQUE JOHNSON ” Practice Location

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