Provider Demographics
NPI:1336830991
Name:JOHNSON, TANIKA
Entity Type:Individual
Prefix:
First Name:TANIKA
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 1:665 MOLINO AVE APT A
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-5457
Mailing Address - Country:US
Mailing Address - Phone:323-507-1152
Mailing Address - Fax:
Practice Address - Street 1:665 MOLINO AVE APT A
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90814-5457
Practice Address - Country:US
Practice Address - Phone:562-380-8975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula