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NPI Code Detail

MEDICARE: LATOSHA D JOHNSON

MEDICARE: LATOSHA D JOHNSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TF0000XFamily Psychologist

General Provider Information

NPI Number : 1164920435
Entity Type Code : Individual
Provider Name (Legal Business Name) : LATOSHA D JOHNSON
Provider Business Mailing Address
First Line : 4017 FABULOUS FINCHES AVE
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89084-4808
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4017 FABULOUS FINCHES AVE
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89084-4808
Country : US
Telephone Number : 702-769-4828
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2018
Last Update Date : 01/31/2018

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Directions to “ LATOSHA D JOHNSON ” Practice Location

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