Individual
LASUNEA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
202 E 108TH ST, LOS ANGELES, CA 90061-2504
(310) 988-6423
Mailing address
202 E 108TH ST, LOS ANGELES, CA 90061-2504
(310) 988-6423
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
198320207
CA
Other
Enumeration date
10/30/2023
Last updated
10/31/2023
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