Provider Demographics
NPI:1679698575
Name:HEARD, JOHNNIE (BA)
Entity type:Individual
Prefix:
First Name:JOHNNIE
Middle Name:
Last Name:HEARD
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7077 ALVERN ST
Mailing Address - Street 2:APT. A327
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-1900
Mailing Address - Country:US
Mailing Address - Phone:323-580-1551
Mailing Address - Fax:
Practice Address - Street 1:2010 E EL SEGUNDO BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90222-7109
Practice Address - Country:US
Practice Address - Phone:310-637-0917
Practice Address - Fax:310-637-0473
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner