Provider Demographics
NPI:1922125772
Name:JOHNSON, LOVELL D
Entity Type:Individual
Prefix:
First Name:LOVELL
Middle Name:D
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 1:2119 N APPLE AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92377-4613
Mailing Address - Country:US
Mailing Address - Phone:626-255-2855
Mailing Address - Fax:
Practice Address - Street 1:330 S OAK KNOLL AVE
Practice Address - Street 2:#210
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3419
Practice Address - Country:US
Practice Address - Phone:626-577-1215
Practice Address - Fax:626-844-6765
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner