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General NPI Number Information
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NPI Number | 1518004472
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Entity Type | Organization
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Legal Business Name | MJ THERAPY SERVICES CORP.
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | CARR. 863 KM. 2.2 BO. PAJAROS CANDELARIA
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City | TOA BAJA
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State | PR
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Zip | 00949-5416
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Country | US
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Telephone | 787-251-5533
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Fax | 787-251-5533
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Provider Business Mailing Address
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Address Line | 119 CALLE RIO LAJAS MONTE CASINO HEIGTHS
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City | TOA ALTA
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State | PR
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Zip | 00953-3750
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Country | US
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Telephone | 787-779-2274
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Fax | 787-779-2274
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | JESSICA ELENA RODRIGUEZ
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Credential |
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Telephone | 787-608-5608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1129
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License Number State | PR
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