Provider Demographics
NPI:1245740521
Name:MRJ MEDICAL INC
Entity Type:Organization
Organization Name:MRJ MEDICAL INC
Other - Org Name:MRJ SERVICES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ KORBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-383-2775
Mailing Address - Street 1:130 S UNIVERSITY DR STE F
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3347
Mailing Address - Country:US
Mailing Address - Phone:954-990-4476
Mailing Address - Fax:954-206-4452
Practice Address - Street 1:130 S UNIVERSITY DR STE F
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3347
Practice Address - Country:US
Practice Address - Phone:954-990-4476
Practice Address - Fax:954-206-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-02
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL020462300261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020462300Medicaid