Provider Demographics
NPI:1962755470
Name:JOHNSTON, ALO CRUZ (MA)
Entity type:Individual
Prefix:MR
First Name:ALO
Middle Name:CRUZ
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:MS
Other - First Name:ALYSSA
Other - Middle Name:CRUZ
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:453 S SPRING ST STE 834
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-2086
Mailing Address - Country:US
Mailing Address - Phone:323-405-4845
Mailing Address - Fax:
Practice Address - Street 1:453 S SPRING ST STE 834
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-2086
Practice Address - Country:US
Practice Address - Phone:323-405-4845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 390200000X
CA390200000X
CA109429106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01536011OtherMEDI-CAL