Dominic Idris Johnson

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Practice address

150 Glen Cove Marina Rd E Ste 102
Vallejo, CA 94591-7237

Phone

(707) 553-1784

NPI assigned

Oct 29, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1540771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540771200000",
    "number": "1104393149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2157 HILLRIDGE DR",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945347950",
            "telephone_number": "707-344-1611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 GLEN COVE MARINA RD E STE 102",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945917237",
            "telephone_number": "707-553-1784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DOMINIC",
        "middle_name": "IDRIS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-29",
        "last_updated": "2018-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Persephone Johnson-McGowan
• Deborah A Johnson-White, LVN
• .Stephan L Johnson
• Cedric Johnson II
• Danielle Johnson
• Kaleas Shafai Johnson, MA
• Kim Michele Johnson
• Margaret Demonet Johnson
• Nichole Johnson
• Rosalyn Johnson, OTR/L

• Behavior Analyst in Vallejo, CA
• Providers in Vallejo, CA by specialty
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.