Individual
JEREMIAH JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LVN
Contact information
Practice address
17199 VITA WAY, RIVERSIDE, CA 92503-7315
(951) 489-2667
Mailing address
17199 VITA WAY, RIVERSIDE, CA 92503-7315
(951) 489-2667
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
215300
CA
Other
Enumeration date
07/02/2025
Last updated
07/02/2025
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