1518004472 NPI number — MJ THERAPY SERVICES CORP.

Table of content: (NPI 1518004472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518004472 NPI number — MJ THERAPY SERVICES CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MJ THERAPY SERVICES CORP.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518004472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119 CALLE RIO LAJAS
Provider Second Line Business Mailing Address:
MONTE CASINO HEIGTHS
Provider Business Mailing Address City Name:
TOA ALTA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00953-3750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-779-2274
Provider Business Mailing Address Fax Number:
787-779-2274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. 863 KM. 2.2
Provider Second Line Business Practice Location Address:
BO. PAJAROS CANDELARIA
Provider Business Practice Location Address City Name:
TOA BAJA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00949-5416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-251-5533
Provider Business Practice Location Address Fax Number:
787-251-5533
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
ELENA
Authorized Official Title or Position:
VICE-PRESIDENT
Authorized Official Telephone Number:
787-608-5608

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  1129 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com