Provider Demographics
NPI:1457011090
Name:JOHNSON, KAMISHA
Entity Type:Individual
Prefix:
First Name:KAMISHA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3107 CRYSTAL LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-0369
Mailing Address - Country:US
Mailing Address - Phone:951-529-0499
Mailing Address - Fax:
Practice Address - Street 1:3107 CRYSTAL LAKE RD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-0369
Practice Address - Country:US
Practice Address - Phone:951-529-0499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)