Deantwann Johnson

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

1126 W Foothill Blvd
Suite 150
Upland, CA 91786-3768

Phone

(909) 982-8641

NPI assigned

Oct 15, 2014

Last updated

Oct 15, 2014By the provider in NPPES

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Reach Out West End

  • Community/Behavioral Health Agency
  • Jurupa Valley, CA
  • NPI 1215256300
  NPD (past)

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

{
    "created_epoch": "1413331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413331200000",
    "number": "1164826400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1170 N SAN ANTONIO AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917674104",
            "telephone_number": "909-446-9440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1126 W FOOTHILL BLVD",
            "address_2": "SUITE 150",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917863768",
            "telephone_number": "909-982-8641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DEANTWANN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-10-15",
        "last_updated": "2014-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anyssia Johnson
• Ashley C Johnson, CADC-II CA
• Damon Johnson
• Dane George Johnson, DPT
• David M Johnson
• Douglas William Johnson, DDS
• Franklin Martin Johnson Jr., D.O.
• Judith A Johnson, P.T.
• Rachel R Johnson, D.D.S
• Renee Rose Johnson, MSN, RN, FNP

• Community Health Worker in Upland, CA
• Providers in Upland, CA by specialty
• Community Health Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2014; 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.