Provider Demographics
NPI:1245606581
Name:MJ MEDICAL INC.
Entity Type:Organization
Organization Name:MJ MEDICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-526-5350
Mailing Address - Street 1:8893 LA MESA BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-5448
Mailing Address - Country:US
Mailing Address - Phone:619-644-2695
Mailing Address - Fax:
Practice Address - Street 1:8893 LA MESA BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-5448
Practice Address - Country:US
Practice Address - Phone:619-644-2695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier