Healthcare Provider Details

I. General information

NPI: 1598097974
Provider Name (Legal Business Name): LATAURUS JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 N DALLAS AVE
LANCASTER TX
75146-1616
US

IV. Provider business mailing address

918 N DALLAS AVE
LANCASTER TX
75146-1616
US

V. Phone/Fax

Practice location:
  • Phone: 972-218-2272
  • Fax: 214-218-8023
Mailing address:
  • Phone: 972-218-2272
  • Fax: 972-218-8023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number008833
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number008833
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: