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General NPI Number Information
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NPI Number | 1548037633
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Entity Type | Individual
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Provider Name | JOHNSON MOMPOINT
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Gender | Male
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Dates
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Enumeration Date | 12/07/2023
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 865 NW 155TH LN APT 108
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City | MIAMI
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State | FL
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Zip | 33169-6157
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Country | US
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Telephone | 919-407-0712
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Fax |
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Provider Business Mailing Address
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Address Line | 18850 NW 57TH AVE APT 307
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City | HIALEAH
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State | FL
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Zip | 33015-7022
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Country | US
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Telephone | 786-806-7546
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10108
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License Number State | AZ
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