Provider Demographics
NPI:1760214613
Name:JOHNSON, JERLIN ISHMIN (UNIT CLERK)
Entity type:Individual
Prefix:
First Name:JERLIN
Middle Name:ISHMIN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:UNIT CLERK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2254 S BRONSON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-1060
Mailing Address - Country:US
Mailing Address - Phone:831-756-0737
Mailing Address - Fax:
Practice Address - Street 1:351 E 6TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-1402
Practice Address - Country:US
Practice Address - Phone:562-435-7350
Practice Address - Fax:844-662-1120
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other