Provider Demographics
NPI:1639616493
Name:JOHNSON, GLORIA ANNETTE (CASE MANAGER)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:ANNETTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 INDUSTRY WAY STE C
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-4042
Mailing Address - Country:US
Mailing Address - Phone:323-979-9670
Mailing Address - Fax:323-593-5354
Practice Address - Street 1:2620 INDUSTRY WAY STE C
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-4042
Practice Address - Country:US
Practice Address - Phone:323-979-9670
Practice Address - Fax:323-593-5354
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator