Provider Demographics
NPI:1770871279
Name:JOHNSONRODGERS, ALOA (LVN)
Entity type:Individual
Prefix:MRS
First Name:ALOA
Middle Name:
Last Name:JOHNSONRODGERS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28665 WINDRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-8474
Mailing Address - Country:US
Mailing Address - Phone:951-672-3690
Mailing Address - Fax:951-672-3690
Practice Address - Street 1:28665 WINDRIDGE DR
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-8474
Practice Address - Country:US
Practice Address - Phone:951-672-3690
Practice Address - Fax:951-672-3690
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN251365164X00000X
CA336408011171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator