Basic Information
| Provider Information | |||||||||
| NPI: | 1790129385 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | MARIANA | ||||||||
| MiddleName: | MURGUIA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 RIVER RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | EDGEWATER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070201016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2016546397 | ||||||||
| FaxNumber: | 5064999518 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 FOREST RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | BEDFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760215712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2144448665 | ||||||||
| FaxNumber: | 5064999518 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2013 | ||||||||
| LastUpdateDate: | 02/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | R1394 | TX | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.