=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205642196
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MJ PRECISION TESTING CENTER & SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2024
-----------------------------------------------------
Last Update Date | 12/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7402 N 56TH ST STE 100M
-----------------------------------------------------
City | TEMPLE TERRACE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33617-7746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 656-238-4203
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7812 BULLARA DR
-----------------------------------------------------
City | TEMPLE TERRACE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33637-4918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 656-238-4203
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DIRECTOR
-----------------------------------------------------
Name | MEPRINA JOSEPH
-----------------------------------------------------
Credential | RN-BSN
-----------------------------------------------------
Telephone | 239-249-4534
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------