Provider Demographics
NPI:1114674728
Name:JOHNSON CHARON, RASHAAD SHAHIB (CMT)
Entity Type:Individual
Prefix:
First Name:RASHAAD
Middle Name:SHAHIB
Last Name:JOHNSON CHARON
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 S OGDEN DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-5038
Mailing Address - Country:US
Mailing Address - Phone:323-445-1480
Mailing Address - Fax:
Practice Address - Street 1:1829 S OGDEN DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-5038
Practice Address - Country:US
Practice Address - Phone:323-445-1480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76488225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist