Individual
MATTISON BROOKE JOHNSON I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
8615 FLETCHER PKWY UNIT 406, LA MESA, CA 91942-5205
(209) 570-6823
Mailing address
8615 FLETCHER PKWY UNIT 406, LA MESA, CA 91942-5205
(209) 570-6823
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
696096
CA
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F5653277
DRIVER LICENSE
CA
Enumeration date
09/03/2019
Last updated
02/25/2020
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