Provider Demographics
NPI:1407200819
Name:JOHNSON, MARCOS SALVADOR (CSFA, LSA)
Entity Type:Individual
Prefix:
First Name:MARCOS
Middle Name:SALVADOR
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:CSFA, LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29523 COPPER XING
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-2488
Mailing Address - Country:US
Mailing Address - Phone:361-779-2443
Mailing Address - Fax:
Practice Address - Street 1:29523 COPPER XING
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-2488
Practice Address - Country:US
Practice Address - Phone:361-779-2443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSA00732OtherTMB