Provider Demographics
NPI:1790129385
Name:JOHNSON, MARIANA MURGUIA (MD)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:MURGUIA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 RIVER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1016
Mailing Address - Country:US
Mailing Address - Phone:201-654-6397
Mailing Address - Fax:506-499-9518
Practice Address - Street 1:2001 FOREST RIDGE DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5712
Practice Address - Country:US
Practice Address - Phone:214-444-8665
Practice Address - Fax:506-499-9518
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR1394208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation