Provider Demographics
NPI:1710775283
Name:JOHNSON, DEJAKNEEYA LEESHAAY
Entity type:Individual
Prefix:
First Name:DEJAKNEEYA
Middle Name:LEESHAAY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56201 PAPAGO TRL APT 7
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-3239
Mailing Address - Country:US
Mailing Address - Phone:323-809-6380
Mailing Address - Fax:
Practice Address - Street 1:473 EAST CARNEGIE DRIVE
Practice Address - Street 2:200
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-1146
Practice Address - Country:US
Practice Address - Phone:760-237-8070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-25
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician