MEDICARE: LATASHA 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
1	1744P3200X	Prosthetics Case Management

General Provider Information

NPI Number	:	1962082263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATASHA JOHNSON

Provider Business Mailing Address
First Line	:	2201 ARBOR ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-6026
Country	:	US
Telephone Number	:	833-430-4807
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 ARBOR ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-6026
Country	:	US
Telephone Number	:	833-430-4807
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2021
Last Update Date	:	04/11/2021

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Directions to “ LATASHA JOHNSON ” Practice Location

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