Provider Demographics
NPI:1881260693
Name:JOHNSON, VANESSA ANN (LMT, CAHC, CHC)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMT, CAHC, CHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 476
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263-0476
Mailing Address - Country:US
Mailing Address - Phone:760-895-0680
Mailing Address - Fax:
Practice Address - Street 1:290 S SAN JACINTO DR APT 6A
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6392
Practice Address - Country:US
Practice Address - Phone:760-895-0680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14830225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist