Provider Demographics
NPI:1528505377
Name:JOHNSTON, MARIE GALARAGA (FNP-BC)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:GALARAGA
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:GALARAGA
Other - Last Name:MADAMBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3895 BILBERRY RD
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-8915
Mailing Address - Country:US
Mailing Address - Phone:909-449-9328
Mailing Address - Fax:310-362-0313
Practice Address - Street 1:9635 MONTE VISTA AVE STE 205
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2235
Practice Address - Country:US
Practice Address - Phone:909-449-9328
Practice Address - Fax:310-362-0313
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-31
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004376363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95004376OtherFAMILY NURSE PRACTITIONER