Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043401854 |
---|---|
Provider Name | Ms. Joyce Marie Johnson |
First Address | Lawndale, CA 90260-1800 |
Second Address | Pasadena, CA 91107-3406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2007 |
Last Update Date | 14/08/2007 |