Individual
MR. TERRANCE DEVOREA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
911 E MASON LN UNIT 13, ANAHEIM, CA 92805-6404
(714) 386-2445
Mailing address
911 E MASON LN UNIT 13, ANAHEIM, CA 92805-6404
(714) 386-2445
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
D3912551
CA
Other
Enumeration date
06/09/2023
Last updated
06/12/2023
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