Provider Demographics
NPI:1083707160
Name:MJ HEALTH CENTERS LLC
Entity Type:Organization
Organization Name:MJ HEALTH CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-438-1188
Mailing Address - Street 1:2159 SW 22ND ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2627
Mailing Address - Country:US
Mailing Address - Phone:305-438-1188
Mailing Address - Fax:305-438-1133
Practice Address - Street 1:2159 SW 22ND ST
Practice Address - Street 2:SUITE B
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-2627
Practice Address - Country:US
Practice Address - Phone:305-438-1188
Practice Address - Fax:305-438-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101475Medicare ID - Type Unspecified