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General NPI Number Information
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NPI Number | 1447969894
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Entity Type | Organization
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Legal Business Name | MJSQUARED LLC
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Dates
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Enumeration Date | 11/15/2022
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Last Update Date | 11/15/2022
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Provider Practice Location Address
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Address Line | 920 SACRAMENTO AVE
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City | SPRING VALLEY
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State | CA
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Zip | 91977-4938
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Country | US
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Telephone | 619-203-7333
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Fax |
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Provider Business Mailing Address
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Address Line | 2570 FERN VALLEY RD
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City | CHULA VISTA
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State | CA
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Zip | 91915-1560
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Country | US
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Telephone | 619-370-8860
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Fax | 619-934-8965
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOSEPHINE DIO
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Credential |
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Telephone | 323-574-6122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number |
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License Number State |
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