Provider Demographics
NPI:1588971428
Name:JOHNSON, BOSHANDA (CHHA)
Entity type:Individual
Prefix:MS
First Name:BOSHANDA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CHHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5384
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90749-5384
Mailing Address - Country:US
Mailing Address - Phone:323-833-6975
Mailing Address - Fax:424-785-7455
Practice Address - Street 1:17420 NAUSET CT
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-1638
Practice Address - Country:US
Practice Address - Phone:323-833-6975
Practice Address - Fax:424-785-7455
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2011-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00781852374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide