Provider Demographics
NPI:1548037633
Name:MOMPOINT, JOHNSON
Entity type:Individual
Prefix:
First Name:JOHNSON
Middle Name:
Last Name:MOMPOINT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18850 NW 57TH AVE APT 307
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-7022
Mailing Address - Country:US
Mailing Address - Phone:786-806-7546
Mailing Address - Fax:
Practice Address - Street 1:865 NW 155TH LN APT 108
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-6157
Practice Address - Country:US
Practice Address - Phone:919-407-0712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10108363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant