Individual
DEANTWANN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1126 W FOOTHILL BLVD, SUITE 150, UPLAND, CA 91786-3768
(909) 982-8641
Mailing address
1170 N SAN ANTONIO AVE, POMONA, CA 91767-4104
(909) 446-9440
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
10/15/2014
Last updated
10/15/2014
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