Provider Demographics
NPI:1528954385
Name:JOHNSON, NINA ANN
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53290 AVENIDA NAVARRO
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-5417
Mailing Address - Country:US
Mailing Address - Phone:760-590-5826
Mailing Address - Fax:
Practice Address - Street 1:53290 AVENIDA NAVARRO
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-5417
Practice Address - Country:US
Practice Address - Phone:760-590-5826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst