Individual
IRESHA OLIVIA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6666 GREEN VALLEY CIR, CULVER CITY, CA 90230-7068
(323) 616-5058
Mailing address
6666 GREEN VALLEY CIR, CULVER CITY, CA 90230-7068
(323) 616-5058
(424) 506-8329
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
175T00000X
CA
Other
Enumeration date
05/08/2025
Last updated
05/08/2025
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