Individual
MS. DOMONIQUE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1848 COMMONWEALTH AVE APT 54, BRIGHTON, MA 02135-6006
(323) 447-0088
Mailing address
1848 COMMONWEALTH AVE #54, BRIGHTON, MA 02135
(323) 447-0088
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/23/2011
Last updated
09/23/2011
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