Tyneika Jovan Johnson-Dodge, LVN

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

234008 Issued in CA

Practice address

928 Broadway
San Diego, CA 92101-5514

Phone

(619) 977-3716

Fax

(619) 481-3075

NPI assigned

Jun 11, 2021

Sex

Female

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

State licenses

Practice roles

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

• Community Research Foundation Inc

  dba Senior IMPACT

  • Community/Behavioral Health Agency
  • San Diego, CA
  • NPI 1255693420
  NPD (past)
• Community Research Foundation Inc

  • Community/Behavioral Health Agency
  • San Diego, CA
  • NPI 1952328700
  NPD (past)

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

{
    "created_epoch": "1623369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641945600000",
    "number": "1184292658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "928 BROADWAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921015514",
            "telephone_number": "619-977-3716",
            "fax_number": "619-481-3075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "928 BROADWAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921015514",
            "telephone_number": "619-977-3716",
            "fax_number": "619-481-3075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON-DODGE",
        "first_name": "TYNEIKA",
        "middle_name": "JOVAN",
        "credential": "LVN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-11",
        "last_updated": "2022-01-12",
        "certification_date": "2021-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "234008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeremiah Vincent Johnsen, B.S.
• Kelsey Rae Johnsen
• Johnson and Tasto Partnership (Scripps West Dental)
• Roland Johnson III
• Jasmine Antonia Johnson-Bowles
• Karyn Johnson-Fernandez, OTR/L
• Erica Victoria Johnson-Herrera, OT
• Jennifer Michele Johnson-Patel, M.D.
• Casie Johnson-Taylor, LMFT
• Adam Wade Johnson

• Licensed Vocational Nurse in San Diego, CA
• Providers in San Diego, CA by specialty
• Licensed Vocational Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2022; 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.