1528505377 NPI number — MARIE GALARAGA JOHNSTON FNP-BC

Table of content: MARIE GALARAGA JOHNSTON FNP-BC (NPI 1528505377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528505377 NPI number — MARIE GALARAGA JOHNSTON FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSTON
Provider First Name:
MARIE
Provider Middle Name:
GALARAGA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MADAMBA
Provider Other First Name:
MARIE
Provider Other Middle Name:
GALARAGA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528505377
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3895 BILBERRY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN BERNARDINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92407-8915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-449-9328
Provider Business Mailing Address Fax Number:
310-362-0313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9635 MONTE VISTA AVE STE 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTCLAIR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91763-2235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-449-9328
Provider Business Practice Location Address Fax Number:
310-362-0313
Provider Enumeration Date:
01/31/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  95004376 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 95004376 . This is a "FAMILY NURSE PRACTITIONER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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