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General NPI Number Information
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NPI Number | 1699194423
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Entity Type | Organization
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Legal Business Name | MJ MEDICAL GROUP,INC.
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Dates
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Enumeration Date | 04/09/2014
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 2097 COMPTON AVE. BLDG#1- SUITE# 103
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City | CORONA
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State | CA
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Zip | 92881-7289
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Country | US
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Telephone | 949-306-5115
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Fax |
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Provider Business Mailing Address
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Address Line | 3943 IRVINE BLVD BOX#40
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City | IRVINE
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State | CA
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Zip | 92602-8840
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Country | US
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Telephone | 951-934-0505
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Fax |
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Authorized Official
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Title or Position | ADMIN
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Name | MRS. ROULA JAMAL
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Credential |
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Telephone | 949-306-5115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | A46078
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License Number State | CA
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