Provider Demographics
NPI:1750132981
Name:AIDOO, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:AIDOO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5584 LARCH AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92377-3942
Mailing Address - Country:US
Mailing Address - Phone:840-356-2919
Mailing Address - Fax:
Practice Address - Street 1:1500 S HAVEN AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-2969
Practice Address - Country:US
Practice Address - Phone:909-749-5204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician