Provider Demographics
NPI:1932394681
Name:JOHANSON, MISHELLE ARGUZON
Entity Type:Individual
Prefix:
First Name:MISHELLE
Middle Name:ARGUZON
Last Name:JOHANSON
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 1:2385 ROSCOMARE RD
Mailing Address - Street 2:#E8
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1838
Mailing Address - Country:US
Mailing Address - Phone:213-840-0814
Mailing Address - Fax:310-476-1881
Practice Address - Street 1:2385 ROSCOMARE RD
Practice Address - Street 2:#E8
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90077-1838
Practice Address - Country:US
Practice Address - Phone:310-966-7877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT5034225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist