Provider Demographics
NPI:1619410305
Name:JOHNSON, DARREN (MPH, RD)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2570 W LINCOLN AVE
Mailing Address - Street 2:APT 23
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-6479
Mailing Address - Country:US
Mailing Address - Phone:626-224-8006
Mailing Address - Fax:
Practice Address - Street 1:2570 W LINCOLN AVE
Practice Address - Street 2:APT 23
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-6479
Practice Address - Country:US
Practice Address - Phone:626-224-8006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86001614133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered