Individual
BRAQUE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
120 ASCOT DR, ROSEVILLE, CA 95661-3400
(916) 787-1100
Mailing address
8434 WALERGA RD, ANTELOPE, CA 95843-5056
(916) 335-5113
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
Y2880508
CA
Other
Enumeration date
12/31/2018
Last updated
12/31/2018
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