Provider Demographics
NPI:1033885884
Name:JOHNSON, DENA (MT NP)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MT NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-3410
Mailing Address - Country:US
Mailing Address - Phone:510-798-7357
Mailing Address - Fax:
Practice Address - Street 1:2316 82ND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-3410
Practice Address - Country:US
Practice Address - Phone:510-798-7357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00238393225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist