Individual
ITAILYA CHEYENNE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1771 E FLAMINGO RD, LAS VEGAS, NV 89119-5155
(760) 710-2460
Mailing address
4647 RIM CIR APT 204, CARLSBAD, CA 92010-4680
(442) 888-7097
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/16/2024
Last updated
05/16/2024
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