Provider Demographics
NPI:1063109015
Name:JOHNSON, MARQUETA (CPHT)
Entity type:Individual
Prefix:
First Name:MARQUETA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-7059
Mailing Address - Country:US
Mailing Address - Phone:409-550-0992
Mailing Address - Fax:
Practice Address - Street 1:440 LOUISIANA ST STE 900
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-1062
Practice Address - Country:US
Practice Address - Phone:281-436-9795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214995183700000X
TX343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No183700000XPharmacy Service ProvidersPharmacy Technician