Provider Demographics
NPI:1326472218
Name:JOHNSON, RUFIS JMAES JR
Entity Type:Individual
Prefix:MR
First Name:RUFIS
Middle Name:JMAES
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4232 VILLAGE DR
Mailing Address - Street 2:APT L
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-2759
Mailing Address - Country:US
Mailing Address - Phone:909-833-1363
Mailing Address - Fax:
Practice Address - Street 1:1556 S SULTANA AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-4238
Practice Address - Country:US
Practice Address - Phone:909-418-6923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker