Provider Demographics
NPI:1487905667
Name:JOHNSON, CEDRIC ARTHUR (CMP)
Entity type:Individual
Prefix:
First Name:CEDRIC
Middle Name:ARTHUR
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:CMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 GARDEN RD
Mailing Address - Street 2:STE. 238
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5311
Mailing Address - Country:US
Mailing Address - Phone:831-320-4845
Mailing Address - Fax:831-886-1685
Practice Address - Street 1:2600 GARDEN RD
Practice Address - Street 2:STE. 238
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5311
Practice Address - Country:US
Practice Address - Phone:831-320-4845
Practice Address - Fax:831-886-1685
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6093225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist