Healthcare Provider Details

I. General information

NPI: 1962082263
Provider Name (Legal Business Name): LATASHA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2021
Last Update Date: 04/11/2021
Certification Date: 04/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 ARBOR ST
HOUSTON TX
77004-6026
US

IV. Provider business mailing address

2201 ARBOR ST
HOUSTON TX
77004-6026
US

V. Phone/Fax

Practice location:
  • Phone: 833-430-4807
  • Fax:
Mailing address:
  • Phone: 833-430-4807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: