Healthcare Provider Details

I. General information

NPI: 1790129385
Provider Name (Legal Business Name): MARIANA MURGUIA JOHNSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2013
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 FOREST RIDGE DR
BEDFORD TX
76021-5712
US

IV. Provider business mailing address

103 RIVER RD STE 101
EDGEWATER NJ
07020-1016
US

V. Phone/Fax

Practice location:
  • Phone: 214-444-8665
  • Fax: 506-499-9518
Mailing address:
  • Phone: 201-654-6397
  • Fax: 506-499-9518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberR1394
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: